Abstract
Indonesia is one of the top ten diabetes mellittus (DM) countries. However as the main complication of DM, there was lack of studies related to diabetic foot ulcer (DFU). Thus, the aim of this study was to survey the prevalence of DFU risk factors and DFU among type 2 diabetes mellitus (T2DM) patients. An epidemiological study was conducted at an outpatient endocrine clinic in a regional hospital, eastern Indonesia. All T2DM participants attending research setting that were ≥ 18 years were included. Demographic and foot care behavior were assessed using minimum data sheet (MDS). Meanwhile, presence of risk factors was evaluated by using 5.07/10 g Semmes-Weinsten Monofilament (SWM) for neuropathy and presence of angiopathy was evaluated with Ankle Brachial Index (ABI) by using a hand held Doppler (Bidop ES-100V3, Hadeco-Kawasaki, Japan) both dorsal and posterior tibialis foot. At the end of study, 249 T2DM participants were enrolled. The prevalence of DFU risk factors was 55.4% (95% CI: 53.7% - 57.0%), and prevalence of DFU was 12% (95% CI: 10.3% - 13.6%). Based on a logistic regression, predictors for DFU risk factors included age (OR: 1.04; 95% CI: 1.005 - 1.074) and daily foot inspection (OR: 0.36; 95% CI: 0.186 - 0.703). Meanwhile, the predictors for presence of DFU were insulin (OR: 9.37; 95% CI: 2.240 - 39.182), shoes (OR: 0.05; 95% CI: 0.007 - 0.294), spiritual belief that DM was a disease (OR: 0.04; 95% CI: 0.004 - 0.326) and belief that DM was a temptation from God (OR: 0.13; 95% CI: 0.027 - 0.598). In conclusion, we recommend to educate high risk patients to understand positive foot care behavior as essentially preventive strategies to prevent presence risk and DFU.
Highlights
Prevalence of Diabetes Mellitus (DM) in Indonesia is high
Diagnosed type 2 diabetes mellitus (T2DM) patients are based on physician endocrine assessment and glycemic status according to American Diabetes Association (ADA) 2013 criteria [16], which are written in hospital medical records
There are 280 T2DM patients who have registered in the research setting, 259 participants agree to participate
Summary
Prevalence of Diabetes Mellitus (DM) in Indonesia is high. As one of the top ten DM countries [1] [2], prevalence of DM in Indonesia has been increasing from year to year. In 1983, prevalence of DM in Indonesia was 1.63% [3], increased 5.7% in 2007 [4] and is predicted to be 6.0% in 2030 [1] or was equal to 8.5 million in 2013 and will be 14.1 million patients in 2035 [2]. International Working Group on Diabetic Foot (IWGDF) has proposed neuropathy and angiopathy as the main risk factors for development DFU [6]. Role of these risk factors has been explained biomechanically [7] and biologically [8]. Most of the studies focused only on neuropathy or angiopathy
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