Diabetic foot in Beijing from a retrospective study

Abstract

Objective To evaluate the diagnostic and therapeutic statusfor diabetic foot in hospitalized patients in Beijing, and investigate factors of severity and prognosis of diabetic foot (DF). Methods The clinical date of 1 646 hospitalized patients with DF from 9 hospitals in Beijing from 2010 Jan 1st to 2014 Dec 31st were retrospective surveyed. 907 of them were enrolled after standardization exam. Statistical analysis was performed for both performing rates and results of foot examination, vascular test and laboratory examination, and also for the influence factors for Wagner gradation. F test or non-parametric Mann-Whitney U test was performed for data analyzing, and chi-square analysis for percentages comparison. Results Among 907 patients with DF, 610 were male, and 297 were female. The mean age was (66.24±11.87) year-old, and 91.0% (421/907) of them were above 50 year-old. The mean duration of diabetes was (13.45±7.71) years, and 71.4%(648/907) of them were over 7 years. Mean HbA1c was (8.70±3.04)%. 46.4%(421/907) of them were diagnosed as peripheral artery disease (PAD), 60.6% (550/907) were diabetic peripheral neuropathy (DPN), 21.6%(196/907) were foot deformity, and 41.2% (374/907) of them had history of DF. 21.5%(195/907)of them had received amputation, and the mortality rate was 1.9%(17/907). Duration of hospital stay was 22.0 (14.0, 30.0) days, and hospitalization expense was 20 904.60 (11 883.53, 37 854.64) RMB. Association analysis showed that Wagner gradation was positively associated with PAD, hospitalization expense and amputation (r=0.191-0.444, all P<0.05), and negatively associated with DPN, hemoglobin (Hb), uric acid (UA), total cholesterol (TC), low density lipoprotein cholesterin (LDL-C) and history of DF (r=-0.169--0.122, P<0.05). Mortality rate increased along with Wagner 1 to 5 grades (Trend-χ2=5.051, Ptrend=0.024) but was not significantly associated (P=0.054). Comparing with non-mortality subgroup, subgroup of mortality had a higher mean age and C-reactive protein (CRP), and a lower Hb and albumin (all P<0.05). Performing rate of foot deformity, PAD and DPN physical examination was 64.2% (582/907), 88.2% (800/907) and 43.3% (393/907), and the performing rate of ABI, HbA1c and WBC was 33.2% (301/907), 58.1% (527/907) and 93.9% (852/907), respectively. Conclusion PAD and poor nutrition status is associated with Wagner grade. Arterial stenosis and DPN could reduce the recovering rate of Wagner grade. Advanced age, severe infection and malnutrition are risk factors of mortality in diabetic foot. Current status of diagnosis and treatment in DF has its defect in some aspects. It is critical to establish the standardized diagnosis and treatment process for DF. Key words: Diabetic foot; Wagner classification; Risk factors; Outcome analysis; Standardized diagnosis and treatment process