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J Liaquat Uni Med Health Sci. 2016; 15(1): 05-11


Diabetic Foot Ulcers in a Tertiary Care Hospital; Risk Factors, Associations and Grades of Presentation

Syeda Saadia Amjad, Nadia Shams, Taqdees Zahra.

Abstract
OBJECTIVE: To determine the various risk factors for diabetic foot ulcers and study their associations.
To study the grades of diabetic foot ulcers at presentation.
STUDY DESIGN: Comparative descriptive study.
SETTING: Department of Medicine; PIMS Hospital, Islamabad.
STUDY DURATION: 15th July 2012 to 15th Jan 2013.
MATERIAL AND METHODS: 254 cases were selected after informed consent. Study group (A)
comprises of 127 cases of type 2 diabetes with diabetic foot ulcer and control group (B) comprises
of 127 cases of age and gender matched type 2 diabetics without foot ulcers. Patients
having ulcer for >4 weeks, who underwent debridement, having serious systemic illness, type I
diabetics and non-diabetic patients presenting with foot ulcer were excluded. Age, gender, duration
of diabetes, duration of ulcer, glycemic control, presence of neuropathy and vascular disease
were documented. Grading and Staging of ulcer was done according to New University of
Texas Diabetic Wound Classification. Various risk factors were compared between the two
groups. Data analyzed via SPSS version 17 with significant p-value < 0.05.
RESULTS: Among 254 cases (68.5 % males & 31.5 % females); mean age was 55.9 + 10.79
(group A) versus 51.9 + 11.4 (group B). Mean duration of diabetes was longer in group A (9.36 +
6.05 years) vs. group B (7.39 + 4.89 years) (p = 0.016). Glycemic control was poor in group A
(64.6 %) vs. group B (52 %) (p = 0.04). There was significantly more peripheral vascular disease
in group A (47.2 %) vs. group B (29 %) (p = 0.005). Sensory neuropathy was more in group A
(94.5 %) vs. group B (39.4 %) (p < 0.0001). Grade-I ulcer was present in 17.32 % cases, Grade-II
in 37.79 % and Grade-III in 44.88 %.
CONCLUSION: Neuropathy carries highest risk for diabetic foot ulcer, followed by peripheral
vascular disease and poor glycemic control. Therefore diabetic patient must be educate about
these risk factor, foot care and self-examination and to have regular screening by clinician. Appropriate
glycemic control and timely medical and surgical intervention may reduce morbidity
in diabetics.

Key words: Diabetic foot ulcer, Glycemic control, New University of Texas Diabetic Wound Classification, Peripheral Neuropathy, Peripheral Vascular Disease.



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