Risk assessment for foot ulcers among Tunisian subjects with diabetes: a cross sectional outpatient study
Open Access
- 24 August 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Endocrine Disorders
- Vol. 20 (1), 1-8
- https://doi.org/10.1186/s12902-020-00608-2
Abstract
Diabetic foot is an underestimated and redoubtable diabetes complication. The aims of our study were to assess diabetic foot ulcer risk factors according to International Working Group on the Diabetic Foot (IWGDF) classification, stratify patients into risk categories and identify factors associated with higher-risk grade. Cross-sectional setting over a period of 07 months, patients were randomly selected from the diabetic outpatients attending our unit of diabetology. Questionnaire and clinical examination were made by the same physician. Patients free of active foot ulcer were included. Among 230 patients evaluated, 10 had an active foot ulcer and were excluded. Five patients (2.27%) had a history of foot ulcer and 3(1.36%) had a lower-limb amputation. Sensory neuropathy, as measured by the 5.07(10 g) Semmes-Weinstein monofilament testing, was present in 23.63% of patients, whereas 36.82% had a peripheral arterial disease based on clinical findings, and 43.63% had foot deformities. According to the IWGDF classification, Group 0: 72.72%, Group 1: 5.9%, Group 2: 17.73% and Group 3: 3.63%. After univariate analysis, patients in higher–risk groups were significantly more often female, had higher age and BMI, longer diabetes duration, elevated waist circumference, low school level, retinopathy and hyperkeratosis. Multivariate logistic regression analysis identified 3 significant independent factors associated with high-risk groups: retinopathy (OR = 2.529, CI95 [1.131–5.655], p = 0.024), hyperkeratosis (OR = 2.658, CI95 [1.222–5.783], p = 0.014) and school level (OR = 0.489, CI95 [0.253–9.44], p = 0.033). Risk factors for foot ulceration were rather common in outpatients with diabetes. The screening of patients at risk for foot ulceration should start early, integrated with sustainable patient education.Keywords
This publication has 36 references indexed in Scilit:
- Prevalence and risk factors of development of peripheral diabetic neuropathy in type 2 diabetes mellitus in a tertiary care settingJournal of Diabetes Investigation, 2014
- Significant J-shaped association between body mass index (BMI) and diabetic foot ulcersDiabetes/Metabolism Research and Reviews, 2011
- Comprehensive Foot Examination and Risk AssessmentDiabetes Care, 2008
- Reevaluating the Way We Classify the Diabetic FootDiabetes Care, 2008
- Microvascular Changes in the Diabetic FootThe International Journal of Lower Extremity Wounds, 2006
- A Review of the Mechanisms Implicated in the Pathogenesis of the Diabetic FootThe International Journal of Lower Extremity Wounds, 2005
- A prospective study of risk factors for diabetic foot ulcer. The Seattle Diabetic Foot Study.Diabetes Care, 1999
- Preventive Foot Care in People With DiabetesDiabetes Care, 1998
- A Foot Risk Classification System to Predict Diabetic Amputation in Pima IndiansDiabetes Care, 1996
- Identifying Diabetic Patients at High Risk for Lower-Extremity Amputation in a Primary Health Care Setting: A prospective evaluation of simple screening criteriaDiabetes Care, 1992