Risk Factors For Foot Ulceration Research Articles

Role of polymorphism in vitamin D receptor gene on diabetic foot ulcer: A systematic review and meta-analysis

Context: Once vitamin D is converted to its active form, the molecule binds to its receptor (VDR) and performs its function as a transcription factor in modulating immune response, inflammation cascade, and insulin signaling. Among diabetic individuals, these activities are thought to be correlated with foot ulceration. Gene polymorphisms could change the function of VDR, thereby affecting the development of foot ulceration among individuals with diabetes. Aims: To construct evidence on the role of VDR gene variants or single nucleotide polymorphisms (SNPs) on diabetic foot ulcers. Methods: Records reporting the distribution of genotypes and/or alleles among diabetic foot ulcer (DFU) patients and published until 10 March 2023 were retrieved from 12 major databases using predetermined keywords. The original research articles included in the study were assessed for reporting quality using the Newcastle Ottawa Scale. The quality of genotypic and allelic data was appraised by Hardy-Weinberg equilibrium (HWE). A quantitative analysis-based fixed-effects model was performed to estimate the proportion of genotype and allele frequencies among DFU patients. Results: Three studies were included in the systematic review reporting the FokI (rs2228570), TaqI (rs731236), BsmI (rs1544410), and ApaI (rs7975232) SNPs. Based on pooled estimates, among DFU patients CC, CT, and TT genotypes of VDR FokI SNPs had a prevalence of 45%, 43%, and 12%, respectively, without significant heterogeneity found in the reported data (p-Het<0.001; I2>0%). ApaI and FokI were associated with DFU, while no association in all genotypic and allelic models was found between TaqI or BsmI and DFU. CC genotype of BsmI and T allele of FokI was associated with oxidative stress (one of the underlying factors in DFU). Conclusions: Certain genotypes and alleles of FokI and ApaI SNPs could act as the risk factor for foot ulceration among diabetic individuals. More high-quality studies are still needed to draw solid conclusions on the role of VDR SNPs among DFU patients.

Risk factors of foot ulcers in patients with end-stage renal disease on dialysis: A meta-analysis.

The present study aims to assess the risk factors for foot ulcers in patients undergoing dialysis for end-stage renal disease (ESRD) and to provide evidence-based guidance for prevention and treatment. A systematic search was conducted on PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Wanfang Data from the database inception until May 2023 to identify relevant studies investigating the risk factors for foot ulcers in dialysis patients with ESRD. Two independent researchers conducted the literature screening and data extraction. The meta-analysis was performed using STATA 17.0 software. Ultimately, six articles comprising 1620 patients were included for analysis. The meta-analysis revealed that male (OR, 1.464; 95% CI: 1.082-1.980, p = 0.013), hypertension (OR, 1.781; 95% CI: 1.293-2.4550, p < 0.001), peripheral artery disease (PAD) (OR, 5.014; 95% CI: 2.514-9.998, p < 0.001), type 1 diabetes mellitus (T1DM) (OR, 2.993; 95% CI: 1.477-6.065, p = 0.002) and type 2 diabetes mellitus (T2DM) (OR, 2.498; 95% CI:1.466-4.256, p = 0.001) were risk factors for foot ulcers in dialysis patients with ESRD. Conversely, the female sex (OR, 0.683; 95% CI: 0.505-0.924, p = 0.013) was a protective factor against foot ulcers. Our analysis revealed that male sex, hypertension, PAD, T1DM and T2DM were risk factors for foot ulcers in patients undergoing dialysis for ESRD. Conversely, the female sex was a protective factor against foot ulcers. Therefore, it is crucial to strengthen health education that targets patients with these risk factors and regularly screen high-risk individuals. Early detection and treatment can help delay disease progression.

Advances in cardiovascular-related biomarkers to predict diabetic peripheral neuropathy.

Diabetic peripheral neuropathy (DPN) is a common chronic complication of diabetes mellitus. One of the most common types is distal symmetric poly-neuropathy, which begins as bilateral symmetry pain and hyperesthesia and gradually progresses into hypoesthesia with nerve fibre disorder and is frequently accompanied by depression and anxiety. Notably, more than half of patients with DPN can be asymptomatic, which tends to delay early detection. Furthermore, the study of adverse outcomes showed that DPN is a prominent risk factor for foot ulceration, gangrene and nontraumatic amputation, which decreases quality of life. Thus, it is essential to develop convenient diagnostic biomarkers with high sensitivity for screening and early intervention. It has been reported that there may be common pathways for microvascular and macrovascular complications of diabetes. The pathogenesis of both disorders involves vascular endothelial dys-function. Emerging evidence indicates that traditional and novel cardiovascular-related biomarkers have the potential to characterize patients by subclinical disease status and improve risk prediction. Additionally, beyond traditional cardiovascular-related biomarkers, novel cardiovascular-related biomarkers have been linked to diabetes and its complications. In this review, we evaluate the association between major traditional and nontraditional car-diovascular-related biomarkers of DPN, such as cardiac troponin T, B-type natriuretic peptide, C-reactive protein, myeloperoxidase, and homocysteine, and assess the evidence for early risk factor-based management strategies to reduce the incidence and slow the progression of DPN.

Validity and reliability of the Polish version of the Michigan Neuropathy Screening Instrument

Diabetic sensorimotor polyneuropathy is an important risk factor for foot ulceration and amputation. Thus, patients with diabetes should be screened for this disorder according to local guidelines. An obstacle to the diagnosis of this disease may be the lack of unified diagnostic criteria due to the lack of properly validated scales used for assessment. To validate both sections (A and B) of the Michigan Neuropathy Screening Instrument (MNSI) in Polish (PL) patients with diabetes. A cross-sectional study using a test (A1, B1) and re-test (A2, B2) formula was performed in 80 patients with diabetes. The gold standard used for neuropathy detection was a nerve conduction study (NCS) which was performed in all participants. Reliability of the MNSI-PL was assessed using the Cronbach's alpha, Kuder-Richardson formula 20 (KR-20), split-half reliability, the Gottman split-half tests, and correlation between first and second half was accessed. Stability was assessed using an intraclass correlation coefficient (ICC). For external validation, we used simple linear correlation, binomial regression, and agreement between two different tools using a Bland-Altman plot analysis. The scale was internally consistent (Cronbach's alpha for the full scale: 0.81 for A and 0.87 for B). MNSI-PL scores in test/retest showed high stability (ICC = 0.73 for A and ICC = 0.97 for B). The statistically important correlations between MNSI-PL and NCS were found for B1, B2, and A1 (P < 0.005). The cut-off points of ≥ 3 for section A (sensitivity of 90%-100%; specificity of 33%-40%) and ≥ 2 for section B (sensitivity of 81%-84%; specificity of 60%-70%) were obtained during neuropathy detection. The MNSI-PL is a reliable and valid instrument in screening for diabetic neuropathy.

Development and Validation of a Risk Prediction Model for Foot Ulcers in Diabetic Patients.

The current study analyzed the status and the factors of foot ulcers in diabetic patients and developed a nomogram and web calculator for the risk prediction model of diabetic foot ulcers. This was a prospective cohort study that used cluster sampling to enroll diabetic patients in the Department of Endocrinology and Metabolism in a tertiary hospital in Chengdu from July 2015 to February 2020. The risk factors for diabetic foot ulcers were obtained by logistic regression analysis. Nomogram and web calculator for the risk prediction model were constructed by R software. The incidence of foot ulcers was 12.4% (302/2432). Logistic stepwise regression analysis showed that BMI (OR: 1.059; 95% CI 1.021-1.099), abnormal foot skin color (OR: 1.450; 95% CI 1.011-2.080), foot arterial pulse (OR: 1.488; 95% CI: 1.242-1.778), callus (OR: 2.924; 95%: CI 2.133-4.001), and history of ulcer (OR: 3.648; 95% CI: 2.133-5.191) were risk factors for foot ulcers. The nomogram and web calculator model were developed according to risk predictors. The performance of the model was tested, and the testing data were as follows: AUC (area under curve) of the primary cohort was 0.741 (95% CI: 0.7022-0.7799), and AUC of the validation cohort was 0.787 (95% CI: 0.7342-0.8407); the Brier score of the primary cohort was 0.098, and the Brier score of the validation cohort was 0.087. The incidence of diabetic foot ulcers was high, especially in diabetic patients with a history of foot ulcers. This study presented a nomogram and web calculator that incorporates BMI, abnormal foot skin color, foot arterial pulse, callus, and history of foot ulcers, which can be conveniently used to facilitate the individualized prediction of diabetic foot ulcers.

Evaluation of Risk Factors for Foot Ulceration in Individuals with Chronic Kidney Disease

Introduction. CKD, like DM, is an independent risk factor for the development and course of foot ulcers. Objective. The authors studied the incidence and risk factors of foot ulceration in patients with CKD and with or without DM and in patients receiving or not receiving HD. Materials and Methods. Patients with or without DM and with renal failure were divided into 4 groups of 40 patients each according to whether or not they were receiving HD. Data were collected using a patient information form, physical examination of the foot, and risk assessment forms. Results. Lower extremity ulceration was highest in group 3 (HD+DM+) (15% [6 of 40]), that is, in patients with CKD and DM receiving HD (P = .421). Patients in group 3 were at highest risk for foot ulcers (72.5%) compared with other groups (P = .001). Risk factors associated with foot ulceration were advanced stage (ie, stage 4 or 5) CKD, HD treatment, age, BMI, history of lower extremity ulceration and/or amputation, foot deformities, skin and nail pathology, neuropathy, and vascular insufficiency. Conclusions. Patients with CKD receiving HD are at high risk for foot ulcers, and this risk increases with the presence of DM.

USE OF FOOTWEAR IN THE EVENT OF FOOT DEFORMITY IN TYPE 2 DIABETES MELLITUS PATIENTS

One of the common complications of diabetes is diabetic foot problems such as deformities. Foot deformity is a risk factor for foot ulcers in diabetic patients. Diabetic foot complications such as diabetic ulcers and amputations will harm the quality of life of diabetic patients. This study aims to explain the relationship between wearing footwear and the incidence of foot deformity in people with type 2 diabetes. The research method was a quantitative study with a cross-sectional study design. The sample in this study consisted of 55 people with an accidental sampling technique. Data were collected through interviews and observations at the feet of the respondents. The types of foot deformities found in the respondents were hallux valgus 7.3%, hallux limitus 3.6%, hallux rigidus 3.6%, flat foot 5.5%, verruca plantaris 1.8%, and callus 7.3%. The results of this study were there is a relationship between the use of footwear and the incidence of foot deformity as evidenced by the Chi-Square statistical test results with a P value of 0.000 (P value &lt; alpha). The results of the study found that the use of poor footwear can affect the shape of the feet, especially in patients with diabetes mellitus.&#x0D; &#x0D;

Incidence, prevalence, and potential risk factors for diabetic foot ulceration: A retrospective review at a multidisciplinary centre in Barbados.

Diabetes and lower extremity amputation rates in Barbados are among some of the highest globally, with peripheral neuropathy and peripheral vascular disease found to be independent risk factors for this population. Despite this, there is currently a lack of research evidence on rates of diabetic foot ulceration, which has amputation as its sequela. We aimed to evaluate the incidence and prevalence rates of active ulceration in a population of people with diabetes in Barbados. Secondly, we explored the risk factors for new/recurrent ulceration. Data were extracted from the electronic medical records for the period January 1, 2019 to December 31, 2020 for a retrospective cross-sectional study for patients of a publicly-funded diabetes management programme. Eligible records included people aged 18 years and above with a diagnosis of type 1 or 2 diabetes. Potential risk factors were explored using univariable logistic regression models. A total of 225 patients were included in the study (96% type 2 diabetes, 70.7% female, 98.7% Black Caribbean). The 1-year period prevalence of diabetic foot ulceration was 14.7% (confidence interval [CI]: 10.5, 20.1). Incidence of ulceration in the same period was 4.4% (CI: 4.4, 4.5). Risk factors associated with diabetic foot ulceration included: retinopathy (OR 3.85, CI: 1.24, 11.93), chronic kidney disease (OR 9.86, CI: 1.31, 74.22), aspirin use (OR 3.326, CI: 1.02, 10.85), and clopidogrel use (OR 3.13, CI: 1.47, 6.68). This study provided some insight into potential risk factors for foot ulceration in this population, which previous studies have shown to have higher rates of lower extremity amputations. Further research in this understudied group through a larger prospective cohort would allow more meaningful associations with risk factors and would be useful for the creation of risk prediction models.

Health Education Programmes to Improve Foot Self-Care Knowledge and Behaviour among Older People with End-Stage Kidney Disease (ESKD) Receiving Haemodialysis (A Systematic Review).

Background: ESKD is a total or near-permanent failure in renal function. It is irreversible, progressive and ultimately fatal without peritoneal dialysis (PD), haemodialysis (HD) or kidney transplantation. Dialysis treatments can create new and additional problems for patients, one of which is foot amputation, as a result of non-healing wounds and vascular complications. The association between dialysis therapy and foot ulceration is linked to several factors: physical and psychological health; peripheral arterial disease (PAD); mobility; tissue oxygenation; manual dexterity; neuropathy; visual acuity; anaemia; nutrition; leg oedema; hypoalbuminemia; infection; inadequacy of dialysis; and leg/foot support during dialysis. The potential risk factors for foot ulceration may include: not routinely receiving foot care education; incorrect use of footwear; diabetes duration; neuropathy; and peripheral arterial disease. Aim: The aim of this review is to examine the factors that help or hinder successful implementation of foot care education programmes for ESKD patients receiving haemodialysis. Method: A comprehensive literature search was completed using five electronic databases. Medline; CINAHL; Embase; PsycINFO; and Cochrane Library. The Joanna Briggs Institute checklist (JBI) was used to quality appraise full text papers included in the review. The systematic review was not limited to specific categories of interventions to enable optimal comparison between interventions and provide a comprehensive overview of the evidence in this important field of foot care. Results: We found no previously published studies that considered foot care education programmes for haemodialysis patients who are not diabetic; thus, the present systematic review examined four studies on diabetic patients receiving haemodialysis exposed to foot care education programmes from various types of intervention designs. Conclusions: This systematic review has provided evidence that it is possible to influence foot care knowledge and self-care behaviours in both diabetic patients receiving haemodialysis and healthcare professionals.

Health-related quality of life of persons with diabetic foot ulcers in a cosmopolitan city in northwestern Nigeria.

Diabetic foot ulcer is one of the most serious and disabling complications of diabetes mellitus (DM). It is a major source of morbidity, mortality, and a leading cause of hospitalization. It constitutes a major burden to the patient, family, and health-care system as well as impairs quality of life (QoL). The aim of this study was to determine the QoL of persons with diabetic foot ulcers attending two major hospitals in a cosmopolitan city in northwestern Nigeria. We conducted a descriptive cross-sectional study at the diabetes outpatient clinics and wards of two major hospitals in Kano, Northwestern Nigeria. Sociodemographic characteristics, type of DM, duration of DM, and the presence of risk factors for foot ulcers were assessed. The QoL of patients with and without foot ulcer was determined a well-validated questionnaire for chronic diseases, short form 36 (SF 36) health-related QoL questionnaire. We recruited 394 patients with DM (163 males and 231 females) with mean age and duration of DM of 50.8 ± 12.5 years and 7.72 ± 6.65 years, respectively. Ninety-five percent of the study participants had type 2 DM. Foot ulcers were present in 57 (14.5%) study participants. The QoL was generally poor (P < 0.001) in patients with DFU, compared with those without DFU in all domains of the SF 36, that indicated poor QoL in the physical, mental, and emotional well-being of the patients. Diabetic foot ulcers are quite common and impart significantly on the QoL of persons with DM affecting their physical, mental, and emotional well-being. Early detection and management of foot ulcers will reduce the burden of the disease and improve the QoL of affected individuals.

Micro- and macrovascular complications and risk factors for foot ulceration and amputation in individuals receiving dialysis with and without diabetes.

IntroductionThis study examined the prevalence of microvascular and macrovascular complications in people receiving dialysis with and without diabetes and investigated independent risk factors for foot ulcers and lower‐extremity amputations.MethodsWe performed a cross‐sectional study of 119 individuals with diabetes and 219 individuals without diabetes receiving chronic dialysis during June 2019 at the Department of Nephrology, Rigshospitalet, University of Copenhagen, Denmark. Effects of diabetes and other risk factors were assessed by log‐binomial regression. Prevalence data were compared with a historical control group of 38 individuals with diabetes receiving dialysis examined in 2004 in the same department.ResultsWe found that persons with diabetes had a twofold higher risk ratio of current (unadjusted risk ratio 2.2 [95% CI 1.1, 4.7]) and previous foot ulcer (2.5 [1.7, 3.7]) and a fourfold higher risk ratio of lower‐extremity amputation (4.2 [2.1, 8.6]) in comparison with persons without diabetes (all p < .05). Furthermore, persons with diabetes had a 70% increased risk ratio of myocardial infarction (1.7 [1.0–2.8], p = .041). In multivariable‐adjusted analysis, current foot ulcer was independently associated with previous foot ulcer (adjusted risk ratio 4.0 [95% CI 1.8, 8.9]), while lower‐extremity amputation was independently associated with diabetes (3.8 [1.8, 8.2]) and male sex (4.1 [1.5, 11.3]) (all p < .01).ConclusionsIndividuals with diabetes receiving dialysis had a higher prevalence of foot ulcer, lower‐extremity amputation and myocardial infarction compared to individuals without diabetes. Previous foot ulcer was the most important risk factor for current foot ulcer, while diabetes and male sex were important risk factors for lower‐extremity amputation.

Knowledge of Risk Factors for Foot Ulceration among Patients with Diabetes Mellitus Attending a Tertiary Health Facility in Nigeria

Objective: Diabetic foot ulcer (DFU) is a relatively common complication of diabetes mellitus and constitutes a major cause of mortality. This study aimed to assess the knowledge of risk factors for foot ulceration among patients with diabetes in a tertiary health facility in South Western Nigeria.&#x0D; Materials and Methods: This cross-sectional study was initiated with participation of 100 diabetic patients. Diabetic patients were attending the medical outpatient clinic of the University College Hospital, Ibadan. A structured and validated questionnaire was administered and data was analyzed using SPSS 22. Association between sociodemographic characteristics and knowledge of risk factors for foot ulceration was evaluated by chi-square test.&#x0D; Results: Most of respondents were female (66%). The mean age of the patients was 58.77 (±11.8) years and 51% of patients did not know that it is possible to develop foot ulcer without feeling pain and 30% did not know that features suggestive of neuropathy could be associated with development of foot ulcer. 75% did not know that surgical vascular repair could play any role in the healing of a diabetic foot ulcer. 11% of patients were walking barefooted at home and as much as 63% of respondents did not know that poor longterm glycemic control could be a risk factor for the development of diabetic foot ulcers.&#x0D; Conclusion: The knowledge of the patients attending the diabetes clinic of a tertiary hospital in south-western Nigeria on foot care is generally poor. Education in this direction is very paramount to correct this defect.

An Introduction to Foot Planter Pressure Measurement System

Foot planter pressure is the area that is between the foot and the surface during daily life activities and other activities. It can help to solve the problems of such disease like gait, diabetes and foot ulceration. It also plays the main role in the patients who are at the risk of variety of foot problems. This paper is about to know the brief discussion on foot related problems. In this article we also discuss the types of foot planter pressure measurement and its future technology. Foot planter system is the system which is very helpful to the patients of foot problems. This system is not only for the patients of foot problems but also used in sports and our daily life. Future applications of the planter pressure to improve in design and more comfortable. High plantar pressures have been shown to be a key risk factor for foot ulceration in people with diabetes. Patients are generally prescribed insoles designed to reduce pressure. New technologies like plantar pressure measurement devices and 3D foot scanners have the potential to improve insole design. Still, it is not clear to what such technologies are currently using by physicians. After that, there has been previous research designed to understand how best to use technology to improve insole design for patients with diabetes.

Risk assessment for foot ulceration in a nigerian diabetic population attending university of Ilorin teaching hospital, Ilorin

Abstract Background: Complications from diabetic foot ulcer often pose a strong threat to the life of patients with diabetes. The aim of this study was to evaluate the risk factors for foot ulceration among people living with diabetes attending University of Ilorin Teaching Hospital, Ilorin, Nigeria. Materials and Methods: One hundred and fifty-one diabetic patients were interviewed with a questionnaire to obtain their sociodemographic, foot care, and diabetes-related details. Both of their feet were then assessed for dermatological changes, musculoskeletal deformities, neurological and vascular complications. Risk stratification was done according to the diabetic foot risk classification system of the International Working Group on Diabetic Foot. Data were analyzed using SPSS version 22. Categorical variables were compared using the Chi-square test while correlation between the risk categories and patients' characteristics was determined using Pearson's Correlation Coefficient, setting statistical significance at P &lt; 0.05. Results and Conclusion: Intermittent claudication was found in 40 patients (26.5%), 76 (50.3) had paresthesia. Eighty nine (58.9%) had foot care education but only 7 (4.6%) had special diabetic foot wears. Impaired monofilament sensitivity was seen in 27 (17.9%) of the right feet and in 23 (15.2%) of the left feet. Significant peripheral neuropathy was detected in 36 (23.9%) on the right and 30 (19.9%) on the left side. It was found that the longer the duration of diabetes, the higher the risk (P = 0.04). Furthermore, patients who had no education had significantly higher risk for diabetes foot ulcer (DFU) (P = 0.01). High risk was discovered among the retirees (P = 0.01). In addition, presence of kidney disease (P = 0.046), cardiovascular disease (P = 0.001), and visual impairment (P = 0.19) all conferred a high risk for developing DFU in our study population. Overall assessment showed that the prevalence of “foot-at-risk' in this study was 30.5% which we think is substantial enough to attract a more serious attention.

Risk factors for foot ulceration among adult patients with diabetes on chronic hemodialysis in Dakahlia Governorate, Egypt

Background Although risk factors for diabetic foot ulceration have been extensively studied in patients with diabetes in Egypt, there is surprisingly limited evidence among those on chronic hemodialysis (CHD). The study aimed to scrutinize the risk factors for foot ulceration in adult patients with diabetes with end-stage renal disease on hemodialysis in Dakahlia Governorate central hemodialysis units.Patients and methods This cross-sectional study included all diabetic patients under CHD aged more than or equal to 18 years (n=98), recruited over 7 months from the largest seven central hemodialysis units in Dakahlia Governorate, Egypt. Data collection consisted of a participant interview, medical record review, and noninvasive comprehensive foot examination. The assessment included peripheral neuropathy, peripheral arterial disease, other foot pathologies, footwear, and foot health care behavior.Results The study included 57 males and 41 females. The median duration of diabetes was 15 (2–33) years. Overall, 61 (62.2%) patients were on insulin therapy. The median duration of hemodialysis was 3 years. Insensate neuropathy and peripheral arterial disease were detected in 65.3 and 15.3% of patients, respectively. The prevalence of foot deformities was 18.36%. Plantar calluses and dry skin were diagnosed in 27.6 and 62.2% of patients, respectively. A total of two (2.04%) patients had active foot ulcers and nine (9.18%) patients had ulcers in remission; therefore, the overall diabetic foot ulceration prevalence was 11.22%. In addition, 10 (10.2%) patients had previous minor amputations, with no reported major amputations. Overall, 95.92% had poor foot health care behaviors, and 81.63% were using inappropriate footwear. None of the included patients previously used custom-made insoles.Conclusions The key finding of this article suggests a high prevalence of risk factors for foot ulceration among diabetic patients receiving hemodialysis. Diabetic foot screening should be included in the management strategy of those on CHD.

Study the susceptibility pattern of bacteria isolated from infected wounds and determine various risk factors associated with foot ulcer

Studying of bacteria prevalence and antimicrobial susceptibility in samples from foot ulcer patients with chronic wounds will provide the epidemiological information on chronic wound infections, representing support for diagnosis, treatment and management of this pathology, thus preventing further complications of foot infection. There are many risk factors associated with a foot ulcer, so identifying those risk factors and preventing them will help in reducing the incidence of the disease to a certain extend. Identifying the type of organisms causing the chronic wound infection, antibiotic sensitivity and resistance representing support for diagnosis, treatment and management thus preventing further complications of foot infection, and to understand the significant risk factors associated with the development of foot ulcers. An interventional study was conducted among the 80 patients with foot ulcers admitted in General surgery ward of a medical college teaching hospital from Dec 2018 to May 2019. Antimicrobial susceptibility results showed that gram-negative organism was more prevalent and among the species, the isolated majority was found to be Staphylococcus aureus 28 (0.35%) followed by Klebsiella 16(20%) and E.coli15(18.75%). The most sensitive antibiotic found was Meropenam70 (87.5%) followed by Imipenam 67(83.75%) and Linezolid 65(81.25%) The most resistant antibiotic was Cotrimoxazole 66(82.5%). This study concludes that high proportion of foot ulcers were found amongst diabetic patients than non-diabetic patients, and were often associated with trauma, cellulitis, gangrene. Some of the critical risk factors for foot ulcers included low educational status, previous history of foot ulcer, previous amputation was done, duration of ulcers, smoking, peripheral neuropathy, infection and HbA1c levels of patients.

Risk factors for foot ulceration among adult patients with diabetes on chronic hemodialysis in Dakahlia governorate, egypt

Background Although risk factors for diabetic foot ulceration have been extensively studied in patients with diabetes in Egypt, there is surprisingly limited evidence among those on chronic hemodialysis (CHD). The study aimed to scrutinize the risk factors for foot ulceration in adult patients with diabetes with end-stage renal disease on hemodialysis in Dakahlia Governorate central hemodialysis units. Patients and methods This cross-sectional study included all diabetic patients under CHD aged more than or equal to 18 years (n=98), recruited over 7 months from the largest seven central hemodialysis units in Dakahlia Governorate, Egypt. Data collection consisted of a participant interview, medical record review, and noninvasive comprehensive foot examination. The assessment included peripheral neuropathy, peripheral arterial disease, other foot pathologies, footwear, and foot health care behavior. Results The study included 57 males and 41 females. The median duration of diabetes was 15 (2–33) years. Overall, 61 (62.2%) patients were on insulin therapy. The median duration of hemodialysis was 3 years. Insensate neuropathy and peripheral arterial disease were detected in 65.3 and 15.3% of patients, respectively. The prevalence of foot deformities was 18.36%. Plantar calluses and dry skin were diagnosed in 27.6 and 62.2% of patients, respectively. A total of two (2.04%) patients had active foot ulcers and nine (9.18%) patients had ulcers in remission; therefore, the overall diabetic foot ulceration prevalence was 11.22%. In addition, 10 (10.2%) patients had previous minor amputations, with no reported major amputations. Overall, 95.92% had poor foot health care behaviors, and 81.63% were using inappropriate footwear. None of the included patients previously used custom-made insoles. Conclusions The key finding of this article suggests a high prevalence of risk factors for foot ulceration among diabetic patients receiving hemodialysis. Diabetic foot screening should be included in the management strategy of those on CHD.

Correlation of Hemoglobin A1c With Wagner Classification in Patients With Diabetic Foot.

IntroductionDiabetic foot is a common complication of diabetes mellitus (DM). The Wagner classification is mostly used to grade its severity. The correlation between the hemoglobin A1c (HbA1c) and the Wagner classification is still controversial. Therefore, the purpose of this study is to determine the correlation of HbA1c with Wagner classification in patients with diabetic foot.Materials and methodsThis cross-sectional study was conducted at a major hospital in Shaheed Benazirabad in which 88 patients aged 18-65 years, of either gender, with a known history of DM type I or type II, and diagnosed with diabetic foot were enrolled for six months. Blood samples were collected to check the HbA1c levels. Wagner classification grading was performed after the examination of diabetic foot ulcers. Demographics such as age, gender, duration of DM, and other risk factors of foot ulcers were also noted. The mean and standard deviation for continuous variables, such as age and HbA1c level, and the frequency and percentage for categorical variables, such as distribution of age, distribution of HbA1c, gender, duration of DM, grades of Wagner classification, and other risk factors of foot ulcers, were calculated. The correlation of HbA1c with Wagner classification was also calculated by applying the chi-square test and taking p ≤ 0.05 as significant.ResultsThe mean age of the study population was 47.4 ± 10.6 years. Of the 88 patients, 15 (17.04%) were 25-35 years of age, 34 (38.63%) were 36-50 years of age, and 39 (44.31%) were 51-65 years of age; 45 (51.13%) patients were males and 43 (48.86%) patients were females. The mean HbA1c level of the study population was 9.07 ± 1.65%; 5 (5.68%) patients had 6.5-7.5%, 34 (38.63%) patients had 7.6-8.5%, 24 (27.27%) patients had 8.6-9.5%, and 25 (28.41%) patients had an HbA1c level of >9.5%. Twelve (13.63%) patients had ≤ 7 years, 18 (20.45%) had 8-15 years, and 58 (65.9%) had >15 years of duration of DM. Zero (0%) patients had grade 0, 1 (1.13%) patient had grade 1, 6 (6.81%) patients had grade 2, 29 (32.95%) patients had grade 3, 32 (36.36%) patients had grade 4, and 20 (22.72%) patients had grade 5 of Wagner classification. 23 (26.13%) patients had foot abnormalities, 19 (21.59%) patients had nephropathy, 13 (14.77%) patients had neuropathy, 14 (15.91%) patients had hypertension, 9 (10.22%) patients had retinopathy, 3 (3.41%) patients had foot ulcers/toe amputation, 2 (2.27%) patients had a cognitive deficit, and 5 (5.68%) patients had cardiovascular diseases. The correlation of HbA1c with Wagner classification was found statistically significant with p < 0.00001.ConclusionsThe older age, male gender, longer duration of DM, increased HbA1c, and previously existing foot abnormalities in diabetic patients are the risk factors of diabetic foot. The monitoring of HbA1c can help predict the diabetic foot in the aforesaid high-risk diabetics because the HbA1c linearly rises with the higher grades of Wagner classification of diabetic foot. Subsequently, the strict control of HbA1c as well as patient education about proper foot care can help prevent diabetic foot and its complications. However, more studies on larger scales are needed to establish the factual relationship between HbA1c and Wagner classification.

A 'Speed-Dating' Model of Wound Care? Rapid, High-Volume Assessment of Patients With Diabetes in a Multidisciplinary Foot Wound Clinic.

Diabetes is a major risk factor for foot ulceration and leg amputation, but the effect of intensive glycaemic control on wound healing is unknown. While an interdisciplinary approach has been shown to be important in the management of diabetic foot ulcer (DFU), there is no standardised definition of such an interdisciplinary team. To investigate the role of an opportunistic, rapid-access, inter-disciplinary model of diabetes care at a foot wound clinic. A retrospective case-control study of patients with DFUs attending a diabetes foot wound clinic over a 6-month period. Outcomes in patients who were seen by a rapid-access interdisciplinary team (RAIT) consisting of an endocrinologist, diabetes educator and dietician during the standard wound care those who were not seen by this team were compared. Fifty-five patients were seen by the RAIT and 64 control patients were not seen by this team during their attendance of a diabetes foot wound clinic. Patients in the intervention group had non-significantly higher baseline HbA1c and a significantly larger proportion were active cigarette smokers. Both groups achieved comparable reduction in the total number of DFUs per patient (p=0.971). Patients in the intervention group had a 60.1% reduction in wound size compared to 52.4% reduction in control group (p=0.526). Our study shows that the use of a rapid-access interdisciplinary team to assess and manage patients' diabetes in a foot wound clinic is feasible. Patients with higher-risk diabetes foot wounds exposed to RAIT had comparable wound healing outcomes to lower risk patients.

Diabetic Foot Ulceration in a Secondary Health Facility

Aims: To determine the prevalence, pattern and presentation of the diabetic foot ulcer.&#x0D; Background: A diabetic foot ulcer is a major complication in diabetes mellitus and probably the major component of diabetic foot. It occurs in 15% of all patients with diabetes and precedes 84% of all lower leg amputations.&#x0D; Poverty, low economic status and ignorance have resulted in this devastating disease. It may worsen in the next decade.&#x0D; There are multiple risk factors that predispose an individual to DM foot ulcer; they include age, gender(male), type of DM, glycaemic (HbA1c) or FBG level, duration of DM (&gt;10yrs) occupational status particular habits of self-foot care and infection.&#x0D; Patients and Methods: This consists of 69 diabetic patients; male and female included done between the months of January 2019 to March 2019.&#x0D; A demographic data questionnaire and social history were obtained. Overnight fasting serum glucose was obtained. Serum glucose was determined by enzymatic glucose oxidase method.&#x0D; Data obtained were subjected to Stata Version 11 Software to determine the graphical representation, mean, standard deviation of the analysis.&#x0D; Results: Thirty-Five 35 were male and 34 were female had type 2 diabetes. Forty-Three 43 patients had foot ulcer, 21 patients had gangrene and 5 had infection. The number of patients with peak glucose values 10 mmol/L and least glucose at 20-25 mmol/L. Those of duration 4-6 years were the most affected the age group most affected is between 40-59 yrs.&#x0D; Discussion and Conclusion: Risk factors for foot ulceration discovered among a host other factors identified in this study, were the infection, low socioeconomic status, improper footwear, poor glycaemic control, structural foot deformity and untreated gangrene.&#x0D; The role of poor glycaemic control in the genesis of diabetic complications cannot be overemphasized as the mean FPG was noted to be considerably higher in patients with foot ulceration As part of a comprehensive foot care programme, education on foot care should be directed at patients, family members and healthcare providers.&#x0D; Not less than 85% of all diabetic foot-related problems are preventable. This can be achieved through a combination of good care of foot, provided by an inter-professional diabetes care team, and appropriate education for people with diabetes.