IDF21-0442 Risk Categorization of Diabetic Foot in Patients with Type-II Diabetes and Influence of Various Risk Factors

Abstract

Background: Diabetes Mellitus has been labelled as global epidemic with 463 million people have diabetes in 2019 and this number is projected to reach 700 million by 2045. Diabetes is the leading cause of nontraumatic amputation. Foot screening which detects and stratification of diabetics which are at the risk of developing diabetic foot ulcer is the simple and useful part of this model of care. Aim: Primary Aim is to stratify patients with type II diabetes into different risk categories of diabetic foot as per International Diabetic Federation guidelines. Secondary Aim is to determine the relationship of various risk factors with risk categories of diabetic foot. Method: Study Design: Cross sectional study. Place and Duration of Study: Department of Medicine, Liaquat University Hospital Jamshoro / Hyderabad from February 2019 to August 2020. Methodology: This study included 117 consecutive patients with confirmed diagnosis of Type-II diabetes of either sex aged ≥ 18 years. Patients fulfilling above criteria were included in study. Feet were thoroughly examined for neuropathy, peripheral vascular disease, infections, ulcers and osteoarthropathy. All the data was recorded on proforma. Patients having normal protective sensations were put in low risk (category 0), those having loss of protective sensations in moderate risk (category 1), those having loss of protective sensations with either high pressure or poor circulation or structural foot deformities or onychomycosis in high risk (category 2) and those having past history of ulceration, amputation or neuropathic fracture were put in very high risk (category 3). Data was analyzed by using SPSS version. 20. Results: Total 117 patients of diabetic foot ulcer were studied, their mean age was 52.28±9.26 years, diabetic duration 10.21±8.10 years and mean HbA1c level was 10.07±1.96 mmol/l. Male were 77(65.8 %). Ulceration history was in 18.8% cases, amputation history was in 7.7% cases, 46 patients (39.3%) had risk category 1. A strong relationship was found between risk categories and age, sex, duration of diabetes, HbA1c. This study revealed that 33 (28%) patients attending the diabetic clinic were at high risk of developing diabetic ulcer. Discussion: Diabetic foot ulcer (DFU) is a major source of morbidity and a leading cause of hospitalization in patients with diabetes. Among 117 diabetic patients 77 (65.8 %) were male and 40 (34.2%) were female in this study. Iqbal S et al. also found similar findings regarding gender as 52 (80%) were male and 13 (20%) female presenting with diabetic foot ulcer out of all 65 study cases. In another study which included 100 patients and risk stratification was done on the basis of American Diabetes Association (ADA) task force report for comprehensive foot examination. According to this classification 48 (48%) patients were in category 0, 33 (33%) in category 1, 19 (19%) in category 2. In a large prospective study comprising 3526 patients which was stratified according to Scottish risk stratification system. According to this system 2257 (64%) were in low risk, 811 (23%) in moderate risk and 458 (13%) high risk category.