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

John Olarinoye; Abiodun Bello; Saint Ogunkeyede; Adebiyi Aderibigbe; Babakayode Olagbaye; Kolawole Wahab

doi:10.4103/liuj.liuj_83_21

Libyan International Medical University Journal, Table of Contents

CC BY-NC-ND 4.0 · Libyan International Medical University Journal 2021; 06(02): 81-90
DOI: 10.4103/liuj.liuj_83_21

Original Article

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

John Olarinoye

Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria

,

Abiodun Bello

Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria

,

Saint Ogunkeyede

¹Department of Surgery, Plastic Surgery Unit, University of Ilorin, Ilorin, Kwara, Nigeria

,

Adebiyi Aderibigbe

¹Department of Surgery, Plastic Surgery Unit, University of Ilorin, Ilorin, Kwara, Nigeria

,

Babakayode Olagbaye

²Department of Anatomy, University of Ilorin, Ilorin, Kwara, Nigeria

,

Kolawole Wahab

³Department of Medicine Neurology Unit, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria

› Author Affiliations

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 < 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.

Key-words:

Diabetic foot ulcer - Nigeria - risk assessment

Full Text

References

References
1 Canadian Diabetes Association Clinical Practice Guidelines Expert Committee; Bowering K, Embil JM. Foot care. Can J Diabetes 2013;37 Suppl 1:S145-9.
2 Rathur HM, Boulton AJ. The neuropathic diabetic foot. Nat Clin Pract Endocrinol Metab 2007;3:14-25.
3 Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA 2005;293:217-28.
4 Rieber GB. The epidemiology of diabetic foot problems. Diabet Med 1996;13 Suppl 1:S6-11.
5 Ogbera OA, Osa E, Edo A, Chukwum E. Common clinical features of diabetic foot ulcers: Perspectives from a developing nation. Int J Low Extrem Wounds 2008;7:93-8.
6 Ogbera AO, Adedokun A, Fasanmade O, Ohwovoriole AE, Ajani M. The “foot at risk” in diabetes mellitus: The Nigerian scenario. Int J Clin Endocrinol Metab 2005;4:165-73.
7 International Diabetes Federation. IDF Diabetes Atlas. 7th ed. International Diabetes Federation; 2016. Available from: http://www.diabetesatlas.org/. [Last accessed on 2016 Oct 13].
8 Shaw JE, Sicree RA, Zimmet PZ. Diabetes atlas: Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87:4-14.
9 World Health Organisation. Global Report on Diabetes; 2016. Available from: http://apps.who.int/iris/bitstream/10665/204871/ 1/9789241565257_eng.pdf. [Last accessed on 2016 Oct 13].
10 Boulton AJ, Kirsner RS, Vileikyte L. Neuropathic diabetic foot ulcers. N Eng J Med 2004;351:48-55.
11 Yakub S, Olamoyegun MA, Onilede DA, Babalola OM, Adamu AN. Sixty second screening for diabetic foot disease: A comparison of two Nigerian teaching hospitals. Wound Heal South Africa 2015;8:65-8.
12 Holstein P, Ellitsgaard N, Olsen BB, Ellitsgaard V. Decreasing incidence of major amputations in people with diabetes. Diabetologia 2000;43:844-7.
13 American Diabetes Association. Consensus development conference on diabetic foot wound care. Diabetes Care 1999;22:1354-60.
14 Boulton AJ, Armstrong DG, Elbert SF, Frykberg RG, Hellman R, Kirkman MS, et al. Comprehensive foot examination and risk assessment: A report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care 2008;31:1679-83.
15 Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Davignon DR, Smith DG. A prospective study of risk factors for diabetic foot ulcer. The Seattle Diabetic Foot Study. Diabetes Care 1999;22:1036-42.
16 Boyko EJ, Ahroni JH, Cohen V, Nelson KM, Heagerty PJ. Prediction of diabetic foot ulcer occurrence using commonly available clinical information: The Seattle Diabetic Foot Study. Diabetes Care 2006;29:1202-7.
17 American Diabetes Association. Consensus development conference on diabetic foot wound care. Diabetes Care 1999;22:1354-60.
18 Fisher RA. The logic of inductive inference (with discussion). J R Stat Soc 1935;98:39-82.
19 World Health Organization. Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycemia: Report of a WHO/IDF Consultation. Geneva: World Health Organization; 2006.
20 Mayfield JA, Sugarman JR. The use of the Semmes-Weinstein monofilament and other threshold tests for preventing foot ulceration and amputation in persons with diabetes. J Fam Pract 2000;49:S17-29.
21 Young MJ, Breddy JL, Veves A, Boulton AJ. The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds: A prospective study. Diabetes Care 1994;17:557-60.
22 Khan NA, Rahim SA, Anand SS, Simel DL, Panju A. Does the clinical examination predict lower extremity peripheral arterial disease? JAMA 2006;295:536-46.
23 Apelqvist J, Bakker K, Van Houtum WH, Nabuurs-Fransen MH, Schaper NC. International consensus on the diabetic foot. In: International Working Group on the Diabetic Foot. Netherland: John Wiley & Sons; 1999.
24 Monteiro-Soares M, Boyko EJ, Ribeiro J, Ribeiro I, Dinis-Ribeiro M. Risk stratification systems for diabetic foot ulcers: A systematic review. Diabetologia 2011;54:1190-9.
25 Adigun I, Olarinoye J. Foot complications in people with diabetes: Experience with 105 Nigerian Africans. Diabetic Foot 2008;11:36-42.
26 Shahbazian H, Yazdanpanah L, Latifi SM. Risk assessment of patients with diabetes for foot ulcers according to risk classification consensus of International Working Group on Diabetic Foot (IWGDF). Pak J Med Sci 2013;29:730-4.
27 Ogbera AO, Adedokun A, Fasanmade OA, Ohwovoriole AE, Ajani M. The foot at risk in Nigerians with diabetes mellitus-the Nigerian scenario. Int J Endocrinol Metab 2005;4:165-73.
28 Amin N, Doupis J. Diabetic foot disease: From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities. World J Diabetes 2016;7:153-64.
29 Firnhaber JM, Powell CS. Lower extremity peripheral artery disease: Diagnosis and treatment. Am Fam Physician 2019;99:362-9.
30 Collins TC, Suarez-Almazor M, Peterson NJ. An absent pulse is not sensitive for the early detection of peripheral arterial disease. Fam Med Kans City 2006;38:38.
31 Zantour B, Bouchareb S, El Ati Z, Boubaker F, Alaya W, Kossomtini W, et al. Risk assessment for foot ulcers among Tunisian subjects with diabetes: A cross sectional outpatient study. BMC Endocr Disord 2020;20:128.
32 Banik PC, Barua L, Moniruzzaman M, Mondal R, Zaman F, Ali L. Risk of diabetic foot ulcer and its associated factors among Bangladeshi subjects: A multicentric cross-sectional study. BMJ Open 2020;10:e034058.
33 Wu L, Hou Q, Zhou Q, Peng F. Prevalence of risk factors for diabetic foot complications in a Chinese tertiary hospital. Int J Clin Exp Med 2015;8:3785-92.