Risk factors for the development of diabetic foot
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v4i2.5252
Abstract
Objective: To determine the risk factors for the development of diabetic foot in patients of the Endocrinology Unit of the Autonomous Institute University Hospital of Los Andes, Mérida,Venezuela. Methods: One hundred type 2 diabetic patients were selected and divided into two groups: 50 patients with diabetic foot (cases) and 50 without diabetic foot (controls), of both sexes, over 18 years of age, matched by age, sex and duration of diabetes. Socio-demographic variables, antecedents, anthropometric measures, disease characteristics, metabolic control, comorbidities and clinical characteristics of the foot were evaluated. Results: There was no association of marital status, education level, psychobiological habits, nutritional status, and presence of arterial hypertension or dyslipidemia, with the presentation of diabetic foot. The predominant lesion in the cases was Wagner grade 2, and according to the Texas classification, it was IIB. There was a significant association of diabetic foot with poor metabolic control (p=0.003; OR:3.451; 95%CI:1.517-7.852), presence of neuropathy (p=0.0001; OR:5.670; 95%CI:2.144-14.997), alteration of the ankle arm index (p=0.004; OR:3.545; IC05%:1.487-8.454) and the personal history of diabetic foot (p=0.0001; OR:8.609; 95%CI:3.110-23.832). In the multivariate logistic regression analysis,the presence of neuropathy, the alteration of the ankle arm index and the personal history of diabetic foot remained as independent predictive factors. Conclusion: The risk factors associated with diabetic foot found in this study are similar to those reported in the world literature. It is very important to maintain adequate metabolic control to avoid neuropathic and angiopathic damage that favor the development of diabetic foot.
Keywords
diabetic foot; risk factors; diabetic neuropathy; diabetic angiopathy
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[27] Meggitt B. Surgical management of the diabetic foot. Br J Hosp Med 1976;16:227-332.
[28] Wagner FW, Jr. The dysvascular foot: a system for diagnosis and treatment. Foot and Ankle1981;2:64-122.
[29] Aboyans V, Criqui MH, Abraham P, Allison MA, Creager MA, Diehm C, Fowkes G, Hiatt W, Jönsson B, Lacroix P, et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation 2012;126:2890-2990.
[30] Hurley L,Kelly A,Garrow P, Glynn L,Mcintosh C,Alvarez-Iglesias A.A prospective study of risk factors for foot ulceration: The West of Ireland Diabetes Foot Study. QJM 2013;106:1103-1110.
[31] Wu L, Hou Q, Zhou Q, Peng F. Prevalence of risk factors for diabetic foot complications in a Chinese Tertiary Hospital, Hunan, China. Int JClin Exp Med 2015;8:3785-3792.
[32] Assaad-Khalil A, Zakib A, Abdel R. Prevalence of diabetic foot disorders and related risk factors among Egyptian subjects with diabetes. Prim Care Diabetes 2015;9:297-303.
[33] Castellano G. Evaluación de riesgo para desarrollo de pie diabético en sujetos con diabetes mellitus tipo 2 (Trabajo especial de grado), Universidad del Zulia 2011;1:1-34 . Accesado en octubre 2016. Disponible en www.tesis.luz.edu.ve/tde_arquivos.com.
[34] Rosales M, Bonilla J, Gómez A, Gómez C, Pardo J, Villanueva L. Factores asociados al pie diabético en pacientes ambulatorios. Salud Uninorte. Barranquilla(Col) 2012;28:65-74.
[35] Yosof N, Rahman J, Zulkifly A, Che-Ahmad A, Khalid K, Sulong A.predictors of major lower limb amputation among tipe 2 diabetic patients admitted for diabetic foot problems. Singapore Med J 2015;56:626-631.
[36] Won SH, Chung CY, Park MS, Lee T, Sung KH, LeeSY, Kim TG, Lee KM. Risk factors associated with amputation-free survival in patient with diabetic foot ulcers.Yonsei Med J 2014;55:1373-1378.
[37] Verrone M, de Sá F, Eduardo A, Toledo M. Risk factor for foot amputation in patients hospitalized for diabetic foot infection. J Diabetes Res 2016;2016:8931508.
[38] Viedé J, Royo J. Pie diabético. Guía para la práctica clínica. 2da edición. Editorial panamericana. Madrid España. 2013.
[39] Rakest S, Rajesh K,Ashwani J, Jagsir M. Diabetic foot disease-incidence and risk factor: a clinical study.J Foot Ankle Res 2016;3:41-46.
[40] Saleem S, Hayat N,Ahmed I,Ahmed T, Rehan A. Risk factors associated with poor outcome in diabetic foot ulcer patients. Turk J Med Sci 2017;47:826-831.
[41] Jeon B, Choi H, Kang J, Tak M, Park E. Comparison of five systems of classification of diabetic foot ulcers and predictive factors for amputation. Int Wound J2017;14:537-545.
[2] Health in the Americas, 2007. Volume I – Regional. World Health Organization.Accesado en abril de 2007. Disponible en: www.who.int/campaigns/world-health.
[3] Anuario de Mortalidad 2011. Ministerio del Poder Popular para la Salud (MPPS). Accesado en abril de 2012. Disponible en: http://www.bvs.gob.ve/anuario/ Anuario2011.
[4] Singh N,Armstrong D,Lipsky B.Preventing foot ulcers in patients with diabetes. JAMA 2005;293:217-228.
[5] Nabuurs- Franssen M. Huijberts M. Health – related quality of life of diabetic foot ulcer patients and their caregivers. Diabetology 2005;48:1906-1910.
[6] Robbins J, Strauss G, Aron D. Rates and diabetic foot ulcers: is it time to communicate mortality risk to patients with diabetes foot ulceration?JAm Podiatr Med Assoc 2008;98:489-493.
[7] Lozano F, González J, March J, Lobos J, Carrasco E, Ros E."Diabetic patients: epidemiology and global impact. J Cardiovasc Surg 2009;50:263-273.
[8] Armstrong D,Wrobel G,Robbins J. Guest Editorial: are diabetes-related wounds and amputations worse than cancer? Int Wound J 2007;4:286-287.
[9] Almaraz M, González-Romero S, Bravo M, CaballeroF, Palomo M, Vallejo R, Esteva I, Calleja F, Soriguer F. Incidence of Lower Limb Amputations in Individuals With and Without Diabetes Mellitus in Andalusia(Spain) From 1998 to 2006. Diabetes Res Clin Pract2012;95:399-405.
[10] Icks A, Haastert B, Trautner C, Giani G, Glaeske G, Hoffmann F. Incidence of lower-limb amputations in the diabetic compared to the non-diabetic population. Findings from nationwide insurance data, Germany,2007-2009. Diabetes Care 2010; 33:2592–2597.
[11] Shahi S, Kumar A, Kumar S, Singh S, Gupta S, Singh T. Prevalence of diabetic foot ulcer and associated risk factors in diabetic patients from North India.J Diab Foot Comp 2012;4:83-91.
[12] Gohel B, Sharma D,Patel B,Raswan U,Patil S.A study of socio demographic and clinical profile of cases of diabetic foot. J Diabetes Res 2012;2:279-281.
[13] Booya F, Bandarian F, Larijani B, Pajouhi M, NooraeiM,LotfiJ.Potential risk factors for diabetic neuropathy: a case control study. BMC Neurol 2005;5:24 . doi:10.1186/1471-2377-5-24.
[14] Islam S,Harnarayan P, Cawich S,Budhooram S,Bheem V, Mahabir V, Ramsewak S, Aziz I, Naraynsingh V. Epidemiology of diabetic foot infections in an eastern caribbean population: a prospective study. Perm J2013;17:37-40.
[15] Weledji EP,Fokam P. Treatment of the diabetic foot –to amputate or not? BMC Surg 2014;24:83-89.
[16] Al-Rubeaan K, Al-Derwish M, Ouizi S, Youssef A, Subhani S, Ibrahaim H, Alamri B. Diabetic foot complications and their risk factors from a large retrospective cohort study.PLoS One 2015;10:e0124446 . doi: 10.1371/journal.pone.0124446.
[17] Pinilla A, Barrera M, Rubio C, Devia D.Actividades de prevención y factores de riesgo en diabetes mellitus y pie diabético.Acta Med Colomb 2014;39:250-257.
[18] Alcántara W, Flores R, Garmendia F. Prevalencia yriesgo de amputación en pacientes con pie diabético. Anales de la Facultad de Medicina 1999;60:159-164.
[19] Camejo M, García A, Rodríguez E, Carrizales M, Chique J.Visión epidemiológica de la diabetes mellitus. Situación en Venezuela. Registro epidemiológico y propuesta de registro. Programas de detección precoz. Rev Venez Endocrinol Metab 2012;10:2-6.
[20] Chiwanga F, Njelekela M. Diabetic foot: prevalence, knowledge, and foot self-care practices among diabetic patients in Dar es Salaam, Tanzania- a croos- sectional study. J Foot Ankle Res 2015;8:1-7.
[21] Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, Guerin C, Bell D, Mechanick J, Pessah-Pollack R, et al.American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for management of dyslipidemia and prevention of cardiovascular disease. Endocr Pract 2017;23:1-87.
[22] Montiel D,Ortiz R,Escamilla. S,Instituto Mexicano delSeguro Social Seguridad y Solidaridad Social. Nivel deconocimiento para el autocuidado de pies en pacientes diabéticos. Accesado en diciembre 2012. Disponible en: https://www.uv.mx/blogs/favem2014/files/2014/06/Protocolo-David.pdf.
[23] National Health and Nutrition Examination Survey 2000. Centers for Disease Control and Prevention. Accesado en marzo de 2017. Disponible en: https://www.cdc.gov/nchs/ nhanes/index.htm.
[24] Feldman E,StevensM,ThomasP,Brown M,Canal N, Greene D. A practical two-step cuantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care 1994;17:1281-1289.
[25] Beneit M. El Síndrome del"Pie Diabético": El Modelo de la Clínica Podológica de la Universidad Complutense de Madrid. Madrid. 2011. Unidad del Pie Diabético y Grupo Interdisciplinar de Estudio de Pie Diabético de la Universidad Complutense de Madrid (911744). Accesado en enero 2013. Disponible en: www. ucm.es/data/cont/docs/.
[26] Armstrong D, Lavery L, Harkless L. Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care 1998;21:855 -859.
[27] Meggitt B. Surgical management of the diabetic foot. Br J Hosp Med 1976;16:227-332.
[28] Wagner FW, Jr. The dysvascular foot: a system for diagnosis and treatment. Foot and Ankle1981;2:64-122.
[29] Aboyans V, Criqui MH, Abraham P, Allison MA, Creager MA, Diehm C, Fowkes G, Hiatt W, Jönsson B, Lacroix P, et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation 2012;126:2890-2990.
[30] Hurley L,Kelly A,Garrow P, Glynn L,Mcintosh C,Alvarez-Iglesias A.A prospective study of risk factors for foot ulceration: The West of Ireland Diabetes Foot Study. QJM 2013;106:1103-1110.
[31] Wu L, Hou Q, Zhou Q, Peng F. Prevalence of risk factors for diabetic foot complications in a Chinese Tertiary Hospital, Hunan, China. Int JClin Exp Med 2015;8:3785-3792.
[32] Assaad-Khalil A, Zakib A, Abdel R. Prevalence of diabetic foot disorders and related risk factors among Egyptian subjects with diabetes. Prim Care Diabetes 2015;9:297-303.
[33] Castellano G. Evaluación de riesgo para desarrollo de pie diabético en sujetos con diabetes mellitus tipo 2 (Trabajo especial de grado), Universidad del Zulia 2011;1:1-34 . Accesado en octubre 2016. Disponible en www.tesis.luz.edu.ve/tde_arquivos.com.
[34] Rosales M, Bonilla J, Gómez A, Gómez C, Pardo J, Villanueva L. Factores asociados al pie diabético en pacientes ambulatorios. Salud Uninorte. Barranquilla(Col) 2012;28:65-74.
[35] Yosof N, Rahman J, Zulkifly A, Che-Ahmad A, Khalid K, Sulong A.predictors of major lower limb amputation among tipe 2 diabetic patients admitted for diabetic foot problems. Singapore Med J 2015;56:626-631.
[36] Won SH, Chung CY, Park MS, Lee T, Sung KH, LeeSY, Kim TG, Lee KM. Risk factors associated with amputation-free survival in patient with diabetic foot ulcers.Yonsei Med J 2014;55:1373-1378.
[37] Verrone M, de Sá F, Eduardo A, Toledo M. Risk factor for foot amputation in patients hospitalized for diabetic foot infection. J Diabetes Res 2016;2016:8931508.
[38] Viedé J, Royo J. Pie diabético. Guía para la práctica clínica. 2da edición. Editorial panamericana. Madrid España. 2013.
[39] Rakest S, Rajesh K,Ashwani J, Jagsir M. Diabetic foot disease-incidence and risk factor: a clinical study.J Foot Ankle Res 2016;3:41-46.
[40] Saleem S, Hayat N,Ahmed I,Ahmed T, Rehan A. Risk factors associated with poor outcome in diabetic foot ulcer patients. Turk J Med Sci 2017;47:826-831.
[41] Jeon B, Choi H, Kang J, Tak M, Park E. Comparison of five systems of classification of diabetic foot ulcers and predictive factors for amputation. Int Wound J2017;14:537-545.
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