Factors associated with diabetic foot among type 2 diabetes in the region of Monastir (Tunisia)

Abstract

Abstract Background The diabetic foot (DF) has actually a high rate of disability leading to impaired quality of life and even mortality. Glycemic control among Tunisian adults with diabetes mellitus remains poor. However the relationship between glycemic control and foot complication have not been clearly established. The aim of the present study was to assess the relationship between diabetic foot lesions and glycemic control and the diabetic duration in the people with DT2. Methods A cross-sectional survey was conducted in five Primary Health care Centers (PHC) in the region of Monastir (Tunisia) from March 2016 to April 2017. Data were collected using interviewer administered structured questionnaire. Validated questionnaire was used to assess diabetic foot diseases.nA multivariate logistic regression analysis was conducted to assess the relationship between glycemic control, diabetic duration and the DF lesions. A p-value of < 0.05 was considered statistically significant. Results In total 383 patients were recruited, of whom 258 (67.9%) were men. The mean age of participants was 60.7±11.3. Poor glycemic control (HbA1c ≥ 7.0%) increased the risk of abnormal patellar reflex (aOR=7.07; CI95% 1.65-30.1; p = 0.03) and calf claudication (aOR=7.07; CI95% 1.65-30.1). The long duration of diabetes (10 years and more) was a significant factor associated with an abnormal Achill reflex (aOR=2.31; CI95% 1.12-4.76; p = 0.02), a needle-stick perceptual disorder(aOR=2.08; CI95% 1.14-3.78; p = 0.01), a vibration sensibility perceptual disorder (aOR=2.02; CI95% 1.01-4.08; p = 0.04), a negative monofilament test (aOR=2.69; CI95% 1.04-5.16; p = 0.003), an absent dorsalis pedis artery pulsation(aOR=2.35; CI95% 1.09-5.05;p=0.02) and an absent posterior tibial artery pulsation (aOR=3.06; CI95% 1.28-7.28; p = 0.01). Conclusions This study identified that disease duration and poor glycemic control are significant risk factors related to DF development in the current T2DM population. Key messages Disease duration and poor glycemic control are significant risk factors related to DF development in the T2DM population in the region of Monastir. Prevention programs should be focused on patient education about modifiable risk factors in particular glycemic control and adequate and regular foot care.