Risk assessment for foot ulcers among Tunisian subjects with diabetes: a cross sectional outpatient study

Prevalence of diabetic foot at risk of ulcer development and its components stratification according to the international working group on the diabetic foot (IWGDF): A systematic review with metanalysis

AIMS

To determine the overall prevalence of diabetic foot at risk according to the International Working Group on the Diabetic Foot stratification.

MATERIALS AND METHODS

We searched PubMed/Medline, Scopus, Web of Science, and Embase. We included cross-sectional studies or cohorts from 1999 to March 2022. We performed a meta-analysis of proportions using a random-effects model. We assessed heterogeneity through subgroup analysis by continent and other characteristics.

RESULTS

We included 36 studies with a total population of 11,850 people from 23 countries. The estimated overall prevalence of diabetic foot at risk was 53.2% (95% CI: 45.1-61.3), I2 = 98.7%, p < 0.001. In the analysis by subgroups, South and Central America had the highest prevalence and Africa the lowest. The factors explaining the heterogeneity were the presence of chronic kidney disease, diagnostic method for peripheral arterial disease, and quality. The estimates presented very low certainty of evidence.

CONCLUSIONS

The overall prevalence of diabetic foot at risk is high. The high heterogeneity between continents can be explained by methodological aspects and the type of population. However, using the same classification is necessary for standardization of the way of measuring the components, as well as better designed general population-based studies.

Risk assessment of amputation in patients with diabetic foot

The prevalence of diabetes has increased dramatically over the past decade, especially in developing countries, reaching pandemic proportions. Although has been the most important factor influencing the prevalence of type 2 diabetes, the prevalence of type 2 diabetes is on the increase among younger adults. The subsequent rate of increase with age is variable, which is more evident in societies where the general prevalence of the disease is higher. Based on clinical and statistical data obtained from the patients who were admitted to The First and Second Surgery Wards in the Sibiu County Emergency University Clinical Hospital (Sibiu, Romania) and the Proctoven Clinic (Sibiu, Romania) between January 2018 and December 2020, the present study attempted to devise a risk score that can be applied for the benefit of patients. The ultimate aim was that this risk score may be eventually applied by diabetologists and surgeons to assess the risk of amputation in patients with diabetic foot lesions. An important part in the therapeutic management of diabetic foot injuries is the assessment of risk factors. Using this risk score system devised, the risk factors that were found to exert influence in aggravating diabetic foot injuries are smoking, obesity, dyslipidaemia, unbalanced diabetes mellitus (glycated haemoglobin ≥7.5%), duration of diabetes >5 years, hepatic steatosis and the co-existence of various heart diseases. To conclude, all these risk factors aforementioned can decrease the effectiveness of treatment and can have a significant impact on the quality of life, if they are not well known.

Diabetic Foot Risk Assessment among Patients with Type 2 Diabetes in Kenya

Background

Screening for diabetic foot complications is often neglected, especially during routine and/or annual diabetes check-ups. We assessed the risk of diabetic foot complications among patients with type 2 diabetes in Kenya using the International Working Group on Diabetic Foot risk stratification guidelines to highlight the need for improved foot care.

Methods

We conducted a descriptive cross-sectional study in Mathari National Teaching and Referral Hospital in Kenya between July and October 2015. Seven hundred patients with type 2 diabetes were identified and 147 were systematically sampled. A trained podiatrist examined patients, and urine and blood samples were taken for biochemical tests and assessed by the investigating team.

Results

In total, 44(29.9%) men and 103(70.1%) women were sampled; 75(51.0%) were aged over 55 years, 113(76.9%) were overweight/obese, 117(79.6%) had poor glycaemic control and 125(85%) had never had their feet screened for complications. Thirty participants (20.4%) were categorised as being at high risk for developing diabetic foot complications while 54(36.7%) had moderate risk, 53(36.1%) had low risk and 10(6.8%) had no risk. Compared to other risk groups, those with moderate risk for developing diabetic foot problems had higher mean levels of glycated haemoglobin (9.4%), albumin-creatinine ratio (50.3) and high-density lipoprotein cholesterol (1.4 mmol/L) at presentation. No other differences in clinical and laboratory profiles were noted.

Conclusion

Our results show high rates of obesity, and poor glycaemic control in patients with type 2 diabetes and 56.5% of patients are categorised as being a moderate-to-high risk for foot problems. This highlights the need for healthcare professionals and patients in Kenya to be sensitised regarding the importance of foot screening to prevent lower-extremity complications.