RESUMO
Objective: To determine the various risk factors for diabetic foot ulcers and study their associations. To study the grades of diabetic foot ulcers at presentation
Study design: Comparative descriptive study
Setting: Department of Medicine; PIMS Hospital, Islamabad
Study duration: 15[th] July 2012 to 15[th] Jan 2013
Material and methods: 254 cases were selected after informed consent. Study group [A] comprises of 127 cases of type 2 diabetes with diabetic foot ulcer and control group [B] comprises of 127 cases of age and gender matched type 2 diabetics without foot ulcers. Patients having ulcer for >/=4 weeks, who underwent debridement, having serious systemic illness, type I diabetics and non-diabetic patients presenting with foot ulcer were excluded. Age, gender, duration of diabetes, duration of ulcer, glycemic control, presence of neuropathy and vascular disease were documented. Grading and Staging of ulcer was done according to New University of Texas Diabetic Wound Classification. Various risk factors were compared between the two groups. Data analyzed via SPSS version 17 with significant p-value < 0.05
Results: Among 254 cases [68.5 % males and 31.5 % females]; mean age was 55.9 +/- 10.79 [group A] versus 51.9 +/- 11.4 [group B]. Mean duration of diabetes was longer in group A [9.36 +/- 6.05 years] vs. group B [7.39 +/- 4.89 years] [p = 0.016]. Glycemic control was poor in group A [64.6 %] vs. group B [52 %] [p = 0.04]. There was significantly more peripheral vascular disease in group A [47.2 %] vs. group B [29 %] [p = 0.005]. Sensory neuropathy was more in group A [94.5 %] vs. group B [39.4 %] [p < 0.0001]. Grade-I ulcer was present in 17.32 % cases, Grade-II in 37.79 % and Grade-III in 44.88 %
Conclusion: Neuropathy carries highest risk for diabetic foot ulcer, followed by peripheral vascular disease and poor glycemic control. Therefore diabetic patient must be educate about these risk factor, foot care and self-examination and to have regular screening by clinician. Appropriate glycemic control and timely medical and surgical intervention may reduce morbidity in diabetics