Diabetic Foot Ulceration. Inpatient Relevant Risk Factors

Résumé ou Introduction

Foot ulcers are one of the most common complications of diabetes mellitus worldwide. According to American Diabetes Association, diabetic foot disease can be attributed to several risk factors. The purpose of this study is to evaluate whether Lebanese diabetic patients with ulcerations, admitted into two hospitals in Beirut, Lebanon, have the same risk factors based on guidelines and review articles.

This is a multicenter, retrospective, observational study conducted from February till May 2013. Every person who presented with a history of diabetes and had diabetic foot ulceration was enrolled in the study. The primary outcome was evaluation of risk factors that lead to diabetic foot ulceration with universal guidelines. The secondary outcome was assessment of the main risk factors leading to hospital admission among these patients. The study was approved by the Institutional Review Board in each hospital. Statistical analysis was done using Statistical Package for the Social Science.
Results: Total number of 2090 diabetic patients was screened and 150 patients were enrolled. Patients who developed foot ulcers were mainly males (74.7%), obese (66.7%), with old age (62.8±11), long duration of diabetes (16.5±8.7), hypertension, previous ulceration, poor glycemic control (HbA1c=10.14±2.04), on oral hypoglycemic agents (70%) and non- satisfactory economic status (62%). Neuropathy and peripheral vascular disease were present in 77.3% and 68.7% of patients respectively (p <0.001). Logistic regressions were done to show that the presence of previous ulceration (p=0.05; OR=2.398; 95% CI= 1.000-5.747) was the only significant predictor for peripheral vascular disease while gender (being a male) (p=0.048; OR=0.399; 95% CI=0.161-0.991), economic status (non- satisfactory) (p=0.049; OR=0.173-0.998; 95% CI=0.173-0.998), and duration (>10 years) (p=0.014; OR=2.898; 95% CI=1.245-6.756) were significantly associated with neuropathy. Furthermore, the average hospitalization days was around 16.9 where the presence of previous ulceration (p=0.027), neuropathy (p=0.02), and previous amputation (p=0.001) were significantly associated with hospitalization.

The study shows that the presence of risk factors leading to diabetic foot ulceration among Lebanese population is compatible with the guidelines. Health care professionals should provide medical counseling to diabetic patients to prevent foot ulceration development.