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ABSTRACT
Aim:
to determine the prevalence and risk factors for
foot complications among diabetic patients.
Method:
prospective study performed in King Hussein Medical
Centre on Jordanian diabetic patients between
June 2008 and January 2010. The following data
was obtained from each patient : age, sex, duration
and type of DM , smoking , presence of hypertension,
the presence of diabetic foot, hyperlipedemia,
retinopathy, nephropathy, Peripheral neuropathy,
peripheral vascular disease , HbA1c level and
body mass index.
Result:
Diabetic foot was present in 95 patients (19.0%).
Amputation was done on 5 patients. Only 26.2%
had HbA1C <7.0 percent. About 2 percent were
current smokers and 66.6% were hypertensive. About
half of the subjects had DM for duration of 10
or more years. 82.6% were obese or overweight.
Hyperlipedemia was present in 28.8%, retinopathy
was present in 42.0% and nephropathy was present
in only 21.2%. Peripheral neuropathy and peripheral
vascular disease was present in 12.2% of patients.
Conclusion:
Tight control of blood sugar and associated risk
factors is important to prevent the development
of diabetic complications. Treating physicians
should be encouraged to exert more attention and
care to foot examination.
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INTRODUCTION
DM is a complex multifactorial
disease; its complications may affect different parts
of the body. One of these complications is diabetic
foot, which refers to foot infection, ulceration or
destruction of deep tissues (1). The pathophysiology
of diabetic foot is mainly foot infection primarily
because of neuropathy, vascular insufficiency, and diminished
neutrophil function (2). Although the risk factors for
the development of diabetic foot are well known, their
influence on the development of diabetic foot are not
well studied in Jordan. The identification of risk factors
is essential if preventive measures are to be taken
for diabetics since diabetic foot is considered one
of the most expensive DM complications to treat, and
if prevented it improves the quality and psychological
status of the patients.
Jordan is considered one of the counties with a high
prevalence of DM and impaired fasting glycemia. In developed
countries the prevalence of DM in adults is 5%(3), while
the prevalence of diabetes in developing countries,
such as the Arab countries, varies from 3 to 35 percent
(4). In a recent study in Jordan, the age-standardized
prevalence of DM and impaired fasting glucose tolerance
were 17.1% and 7.8% respectively, confirming that the
prevalence of DM in Jordan is high and increasing.(5)
The aim of this study was to determine the prevalence
and risk factors for foot complications among diabetic
patients.
METHODS
This is a prospective study performed in the
King Hussein Medical Centre on Jordanian diabetic patients
who attended the internal medicine and endocrine clinic
from June 2008 to January 2010. The following data was
obtained from each patient : age, sex, duration and
type of DM, smoking, presence of hypertension, the presence
of diabetic foot, hyperlipedemia, retinopathy, nephropathy,
Peripheral neuropathy, peripheral vascular disease,
HbA1c level and body mass index.
RESULTS
About 500 patients (255
males, 245 females) with DM. 84.8% were type II DM.
Diabetic foot was present in 95 patients (19.0%). Amputation
was done on 5 patients. The mean age was 52.3 years,
ranging from 25 to 72. Over 40 percent of patients were
within the age group of 50 to 60 years of age. The mean
duration of DM was 10.2 years, ranging from 2 to 26
years. Only 26.2% had HbA1C <7.0 percent. About 2
percent were current smokers and 66.6% were hypertensive.
About half of the subjects had DM for a duration of
10 or more years. 82.6% were obese or overweight. Hyperlipedemia
was present in 28.8%, retinopathy was present in 42.0%
and nephropathy was present in only 21.2%. Peripheral
neuropathy and peripheral vascular disease was present
in 12.2% of patients. Table 1 below summarizes the prevalence
of the studied factors in diabetic patients with and
without diabetic foot.
| Factor |
Diabetic
patients without diabetic foot
|
Diabetic
patients with diabetic foot
|
| Age (years) |
51.6
|
52.8
|
| Duration of DM |
9.8
|
15.2
|
| Male: female |
1.1:1
|
1:1
|
| Smoking |
44.2%
|
64.2%
|
| Hypertension |
55.1%
|
76.1%
|
| Hyperlipidemia |
6.2%
|
6.6%
|
| Retinopathy |
33.6%
|
46.3%
|
| Nephropathy |
9.4%
|
11.5%
|
| Peripheral neuropathy |
12.2%
|
44.5%
|
| Peripheral vascular disease |
12.2%
|
31.6%
|
| HbA1c level |
7.9
|
8.6
|
| Body mass index kg/m2 |
23.5
|
25.1
|
Table
1: Summary of the prevalence of the studied factors
in diabetic patients with and without diabetic foot
- source: researchers, 2010
DISCUSSION
Lower extremity complications
in persons with diabetes have become an increasingly
significant public health concern in both the developed
and developing world. These complications, beginning
with neuropathy and subsequent diabetic foot wounds
frequently lead to infection and lower extremity amputation.
Peripheral neuropathy and peripheral vascular disease
are well known common long-term complications of diabetes,
but many are asymptomatic (6). It is estimated that
15% of diabetic patients will eventually suffer from
foot ulceration during their lifetime (7). Studies of
the incidence of lower limb amputation showed extreme
variability between different areas and ethnic groups.(8)
Studies on the incidence of lower limbs amputation in
diabetics are few and most of them doesn't analyze their
result regarding risk factors. The prevalence of diabetic
foot in diabetic patients was 19.0%. Comparison among
studies is difficult because the prevalence of diabetes
and diabetic foot varies widely depending on the methodology
and populations and no similar recent study was done
in Jordan. The results of this study showed that the
overall prevalence of Peripheral neuropathy and peripheral
vascular disease was present in 12.2% of patients and
was far lower than that reported in other populations
(9,10). This may be due to geographical variation, but
it was present in more than 65% of patients with diabetic
foot and all patients with amputation. This suggests
that it play a major role in the pathogenesis of diabetic
foot. Other evidence is that retinopathy and nephropathy,
which has a similar pathophysiology picture (peripheral
vascular disease), was highly prevalent in patients
with diabetic foot compared to diabetic patients without
diabetic foot. Factors that correlated to amputation
in our study were long standing type II DM, associated
hypertension, uncontrolled DM, high body mass index,
Peripheral neuropathy, peripheral vascular disease and
smoking. Age, sex and lipid profile did not significantly
correlate to diabetic foot. With the presence of high
rates of diabetes in the Jordanian population it is
imperative to emphasize the importance of regular screening
for diabetic foot in all diabetic patients and treatment
of associated risk factors is essential.
CONCLUSION
Tight control of blood
sugar is the most important factor that prevents the
development of diabetic complications. Early detection
and treatment of vascular and neurological deficits,
cessation of smoking, and controlling of associated
hypertension will significantly lower the incidence
of diabetic complications. Treating physicians should
be encouraged to exert more attention and care to foot
examination. With the implementation of good prevention
and treatment programs, a significant reduction of lower
extremity complications will be achieved.
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