PREVALENCE OF RISK FACTORS FOR DIABETIC FOOT ULCER AND RISK STRATIFICATION IN TYPE 2 DIABETES DR. NEETA DESHPANDE ASSOCIATE PROF.,JN MEDICAL COLLEGE AND KLE HOSPITAL, BELGAUM

INTRODUCTION 40-70% of LL amputations related to DM Substantial emotional, physical and financial losses Illiteracy, lack of knowledge Largely preventable through early detection of “high-risk” feet, preventive footwear and counseling

AIMS AND OBJECTIVES To know prevalence of risk factors for diabetic foot ulceration and stratification into risk categories To correlate risk categories to age, duration of DM, glycemic control and SES

INCLUSION CRITERIA All known cases of type 2 DM of more than 1 year duration

EXCLUSION CRITERIA Patients with current foot ulcer Patients of DM admitted for other neurological causes

METHODOLOGY 215 type 2 diabetics who were willing to participate in the study were questioned in detail – age, duration of diabetes, footwear practices, level of education, symptoms of neuropathy, vasculopathy, previous foot ulcer/amputation Thorough foot examination was done Blood sample was collected for HbA1c

Definitions of recorded data HISTORY OF FOOT ULCER – Healed foot ulcer of more than 3 months duration HISTORY OF LL AMP – Non-traumatic amp at any level in the LL PAD – Intermittent claudication or h/o reconstructive vascular surgery and/or absence of foot pulses

Definitions of recorded data - contd SENSORY NEUROPATHY - > 1 “no response” to 10 g MF applied to 10 sites (9 plantar and 1 dorsal) and/or NDS FOOT DEFORMITY – hallux valgus, overlapping toes, fixed clawed toes, pes cavus/planus, Charcot foot, prominent metatarsal heads

NEUROPATHY DISABILITY SCORE – RIGHT AND LEFT Vibration sense (dorsum of big toe) : Present=0, reduced/absent=1 Pin prick : Present=0, reduced/absent=1 Ankle jerk : present=0, present on reinforcement=1, absent=2 absent=2 TOTAL SCORE: 3-4 Mild neuropathy 5-7 Moderate 8-10 Severe

CLASSIFICATION OF INTERNATIONAL WORKING GROUP ON DIABETIC FOOT RISK CATEGORY 0123DESCRIPTION No sensory neuropathy Sensory neuropathy only SN+PVD &/or deformity Previous ulcer/amputation

Statistical Methods.Chi – square test and unpaired ‘t’ test

Age and Sex distribution AGEMALEFEMALETOTAL

Duration of diabetes

Prevalence of risk factors CASESPERCENTAGE Neuropathy Vasculopathy Foot deformity Prev ulcer/amp

Prevalence of risk factors

Neuropathy Disability Score No. Of Cases Percentage Mild (NDS 3- 4) Mod (NDS 5- 7) Severe (NDS 8-10)

Mean duration of diabetes Mean (Years) SD Group Group Group Group

Mean duration of diabetes

Mean Age

Glycemic control HbA1cGood(<8%)Fair ( %) Poor(>10%) Group Group Group Group

Glycemic control

Barefoot walking

Level of education

Conclusions Overall prevalence of neuropathy is higher than vasculopathy (38.6% Vs 10.2%) Age (p<0.01), duration of diabetes (p<0.001) and glycemic control (p<0.01)are significantly correlated to high-risk feet Barefoot walking (p<0.001) and level of education (p<0.0002) are important risk factors