Risk assessment and classification for foot ulceration among patients with type 2 diabetes in South Korea.

Abstract

This study aimed to investigate the distribution of foot conditions, the risk of foot ulceration and its associated factors in patients with diabetes. Few studies have focused on the risk of foot ulceration in patients with diabetes. A total of 267 patients with diabetes who attended outpatient clinics in two tertiary referral hospitals were recruited from June to September 2016. The risk of foot ulceration was classified using the American Diabetes Association (ADA), International Working Group on the Diabetic Foot (IWGDF) and Scottish Intercollegiate Guidelines Network (SIGN) classification systems. The risk categories of each system were reclassified into high- (categories of 2 and 3 for the ADA and IWGDF systems and high for the SIGN system) and low-risk. Foot deformity was the most prevalent condition (38.2%). Among 261 patients without active ulcers, between 17.6% to 35.2% were classified in the high-risk group and overall agreement among systems ranged from .42 to .56 of the kappa statistic. Insulin treatment was consistently associated with a high-risk of foot ulceration. As the risk varies between systems, nurses should select a suitable classification system through validation studies and assess the risk in patients with diabetes, particularly, those receiving insulin treatment.