Risk assessment for foot ulcers among Tunisian subjects with diabetes: a cross sectional outpatient study
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RESEARCH ARTICLE
Open Access
Risk assessment for foot ulcers among Tunisian subjects with diabetes: a cross sectional outpatient study B. Zantour1* , S. Bouchareb1, Z. El Ati1, F. Boubaker1, W. Alaya1, W. Kossomtini2 and M. H. Sfar1
Abstract Background: Diabetic foot is an underestimated and redoubtable diabetes complication. The aims of our study were to assess diabetic foot ulcer risk factors according to International Working Group on the Diabetic Foot (IWGD F) classification, stratify patients into risk categories and identify factors associated with higher-risk grade. Methods: Cross-sectional setting over a period of 07 months, patients were randomly selected from the diabetic outpatients attending our unit of diabetology. Questionnaire and clinical examination were made by the same physician. Patients free of active foot ulcer were included. Results: Among 230 patients evaluated, 10 had an active foot ulcer and were excluded. Five patients (2.27%) had a history of foot ulcer and 3(1.36%) had a lower-limb amputation. Sensory neuropathy, as measured by the 5.07(10 g) Semmes-Weinstein monofilament testing, was present in 23.63% of patients, whereas 36.82% had a peripheral arterial disease based on clinical findings, and 43.63% had foot deformities. According to the IWGDF classification, Group 0: 72.72%, Group 1: 5.9%, Group 2: 17.73% and Group 3: 3.63%. After univariate analysis, patients in higher– risk groups were significantly more often female, had higher age and BMI, longer diabetes duration, elevated waist circumference, low school level, retinopathy and hyperkeratosis. Multivariate logistic regression analysis identified 3 significant independent factors associated with high-risk groups: retinopathy (OR = 2.529, CI95 [1.131–5.655], p = 0.024), hyperkeratosis (OR = 2.658, CI95 [1.222–5.783], p = 0.014) and school level (OR = 0.489, CI95 [0.253–9.44], p = 0.033). Conclusions: Risk factors for foot ulceration were rather common in outpatients with diabetes. The screening of patients at risk for foot ulceration should start early, integrated with sustainable patient education. Keywords: Diabetic foot ulcer, Risk factors, IWGDF classification, Screening
Background Diabetic foot ulceration is one of the most severe complications of diabetes. Eighty-five percent of nontraumatic amputations in diabetic patients are preceded by foot injury [1]. The main mechanisms causing the lesions are the peripheral sensory neuropathy (PSN), the * Correspondence: [email protected] 1 Department of endocrinology and internal medicine, Tahar Sfar hospital, 5100 Mahdia, Tunisia Full list of author information is available at the end of the article
peripheral artery disease (PAD), which can be associated in varying degrees, in combination with other factors such as microvascular disease, biomechanical abnormalities and limited joint mobility [2]. It is important to identify people with diabetes at risk of developing foot lesions using a classification easy to apply in daily practice in order to facilitate diabetic foot asses
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