Determinants for Developing Foot Ulcer Among Persons with Diabetes Mellitus Attending Outpatient Clinic in a Tertiary Hospital in Nigeria
Date
2019-11
Authors
Olopade, O.B
Odeniyi, I.A
Olusanya, A.W
Sowemimo, O.E
Akinsola, C.M
Fasanmade, O.A
Journal Title
Journal ISSN
Volume Title
Publisher
British Endocrine Society
Abstract
Introduction
Diabetes mellitus prevalence in Nigeria is on the rise and it is estimated to be about 5.77%.1 One of the most dreaded complications seen among persons with diabetes mellitus (DM) is diabetes foot ulcer (DFU). DFU is a chronic complication not desired in individuals with DM. DFU occurs in the setting of one or a combination of neuropathy, vasculopathy and infection and where appropriate measures are not taken, it can lead to amputation of part or the whole limb.2 This subsequently reduces the productivity and the economic power of the affected persons and the society at large. Identifying risk factors leading to the development of DFU is of paramount importance in preventing its occurrence. This study aimed to identify risk factors to the development of DFU among DM patients attending the diabetes outpatient clinic of Lagos University Teaching Hospital (LUTH), Lagos Nigeria.
Method
This was a cross-sectional study in which 296 consenting individuals with DM attending LUTH diabetes Medical outpatient clinic were enrolled. Interviewer-administered questionnaire utilized included a history of previous ulcers, burning sensation, numbness, intermittent claudication, pin and needle sensation and visual impairment. Patients were assessed clinically with emphasis on foot examination. Anthropometric and biochemical measurements were also obtained. 10g monofilament and ankle-brachial index were used for foot examination. Ethical approval was obtained from the health and ethics research committee of LUTH.
Data were analysed using SPSS version 25. Continuous variables were obtained using the student t-test while frequency distributions were obtained for categorical variables. The Chi-square test was used to assess the significance of the association between foot ulcers and risk factors. Odds ratios were calculated using logistic regression after adjusting for age and gender. p-value ≤0.05 was considered significant.
Result
The mean age of participants was 60.58±11.3 years of which females were 61.8%. Twenty-three individuals (7.8%) had past history of DFU. A significant proportion of participants were hypertensive (75.7%) and overweight/obese (67.6%) as seen in table 1. Some of the common risk factors identified in table 2 for the development of DFU include visual impairment (63.2%), skin dryness (52%), inappropriate footwear (51.7%) pin and needle sensation (50.3%), numbness (39.4%), hair loss (32.8%), cracks (29.4%), burning sensation (24%) amongst others.
Discussion
Diabetes foot ulcer(s) is a distressing chronic complication seen in people with DM. Lack of proper care can lead to revascularization or amputation of part or whole limb, which is an unpleasant therapeutic option.2 In this study, the incidence of DFU is 7.8% which is similar to a study done at Vellore, South India.3 It was found that the male sex and ages between 51 to 60 years are major contributors to DFU. It is known that men have poor health-seeking behaviour and tend to present late to health care facilities in Africa settings. The reason for the high incidence of DFU in the sixth decade of life is unknown but could be due to probably prevalence of visual impairment among those with DFU, which is about 65%. One-third (34%) of our patients with DFU have peripheral arterial disease. This contributes significantly to the development of vasculopathy.
Other Risk factors identified in this study contributing significantly to the development of DFU include increasing duration of DM (more than 45% of patients have DM of greater than 10years) and crackles which are features of neuropathy. Other features of neuropathy identified include burning sensation, pins and needle sensation, numbness, loss of hair, dilated veins. Some of the vasculopathy features accessed included intermittent claudication, xerosis, and deep vein thrombosis. The presence of all these risk factors contribute to the development of DFU.3
Inappropriate footwear was observed in more than half of the participant’s despite regular education (in groups or individual education) at every clinic visit. None availability of podiatrists in our clinic to complement foot care efforts by other health care professionals could have helped to reduce this habit. Inappropriate footwear has been noted to be a major contributor to abnormal foot mechanics thus leading to foot deformity.
Almost half of participants (49.3%) had good glycaemic control, as those with DFU have better-glycosylated haemoglobin than those without DFU. The reason for this is unknown in this study but this finding is an indication that the development of DFU is beyond glycaemic control.
Conclusion
Regular screening for DFU risk factors in our day to day practice is essential along with prevention of microvascular and reduction in macrovascular complications. Inappropriate footwear which contributes to the distortion of the foot mechanics should be discouraged especially in patients with a prolonged history of DM and crackles.
Description
Conference presentation
Keywords
Diabetes mellitus , Foot ulcers , Foot mechanics , Patients , LUTH , Research Subject Categories::MEDICINE
Citation
Olopade OB, Odeniyi IA, Olusanya AW, Sowemimo OE, Akinsola CM, Fasanmade OA. Determinants for Developing Foot Ulcer Among Persons with Diabetes Mellitus Attending Outpatient Clinic in a Tertiary Hospital in Nigeria. Book of Abstracts, British Endocrine Society