The risk factors of developing diabetic foot ulcers incidence with diabetic patients in Mukalla/Yemen
Background: Diabetes is on the rise worldwide and is already considered as an epidemic by some experts. So, there is a need to raise awareness on the important factors that can help prevent bacterial infection in wounds of patients with diabetes.
Objective: To study the risk factors of developing diabetic foot ulcer (DFU) in patients with diabetes. The study is the first in Yemen to investigate the prevalence of bacterial infection in wounds of diabetic patients.
Materials and Methods: This is a case-control study carried out from November 2018 to May 2019. Twenty diabetic patients with foot ulcer and twenty without foot ulcer were examined. Risk factors and clinical profile of patients were studied by using a standardized questionnaire that included gender, age groups, past history of diabetes, duration of the disease, type of diabetes, DFU, type of ulcer, smoking, glucose level, and control of blood glucose level.
Results: The risk factors that affected significantly the occurrence of DFU were gender (0.038), age groups (0.010), and duration of diabetes mellitus (DM) while hyperglycemic control, smoking, and family history were not. There was no significant difference (0.977) in mean fasting blood glucose (MBG) between the DM and DFU patients.
Conclusions: Male diabetic patients aged more than 55 years and suffering from DM for more than 10 years were most likely to have DFU.
Key words: diabetic foot ulcer, diabetes mellitus, risk factors, Yemen
1. Rosyid F.N. Etiology, Pathophysiology, diagnosis and management of diabetic’s foot ulcer. International Journal of Research in Medical Sciences. 2017; 5(10): 4206-4213.
2. Saleem S., Hayat N., Ahmed T. et al. Risk factors associated with poor outcome in diabetic foot ulcer patients. Turk J Med Sci. 2017; 47: 826-831.
3. Balla S., Ahmed H., Alhassan S. Factors Associated with Diabetic Septic Foot Among Patients Attending the Diabetic Septic Foot Unit in the Military Hospital, Khartoum State, Sudan. Saudi J Med Med Sci. 2013; 1(2): 98-102.
4. Wangnoo S. Diabetic foot: Clinical presentation and management in 2015. Journal of Indian College of Cardioogy. 2016; 6s, 58-60.
5. Khan Y., Khan M., Farooqui M. Diabetic foot ulcers: a review of current management. Int J Res Med Sci. 2018b; 5(11): 4683-4689.
6. Patil A., More D., Patil A. et al. Clinical, Etiological, Anatomical, and Bacteriological Study of “Diabetic Foot” Patients: Results of a Single Center Study. Cureus Journal. 2018; 10(4): 1-9.
7. Zaine N.H., Burns J., Vicaretti M. et al. Characteristics of diabetic foot ulcers in Western Sydney, Australia. Journal of Foot and Ankle Research. 2014; 7(39): 1-7.
8. Wu M., Pan H., Leng W. et al. Distribution of Microbes and Drug Susceptibility in Patients with Diabetic Foot Infections in Southwest China. Journal of Diabetes Research. 2018; 1-9.
9. Malepati S., Vakamudi P., Kandati J. et al. Bacteriological study of diabetic foot ulcer according to Wagner’s classification: a one-year study. Int Surg J. 2018; 5(1): 98-104.
10. Aamir A., Nasir A., Jadoon M. et al. Diabetic Foot Infections and Their Management in A Tertiary Care Hospital. J Ayub Med Coll Abbottabad. 2011; 23(1): 58-62.
11. Yazdanpanah L., Shahbazian H., Nazari I. et al. Incidence and Risk Factors of Diabetic Foot Ulcer: A Population-Based Diabetic Foot Cohort (ADFC Study)—Two-Year Follow-Up Study. International Journal of Endocrinology. 2018; 1-8.
12. Ahmed M., Said M., Naira E. et al. Infection in diabetic foot. Menoufia Med J, 2013; 26, 49–53.
13. Al-Salihi S.S. Jumaah I.A. Bacterial infection of Diabetic foot ulcer. Diyala Journal for Pure Sciences. 2013; 9(4): 15-20.
14. Manda V., Sreedharan J., Muttappallymyalil J. et al. Foot ulcers and risk factors among diabetic patients visiting Surgery Department in a University Teaching Hospital in Ajman. International Journal of Medicine and Public Health. 2012; 2(3): 34- 38.
15. Ogba O., Nsan E., Eyam E. Aerobic bacteria associated with diabetic foot ulcers and their susceptibility pattern. Biomedical Dermatology. 2019; 3(1): 1-6.
16. Al Kafrawy N.A., Mustafa E.A., Dawood A.E. et al. Study of risk factors of diabetic foot ulcers. Menoufia Med J. 2014; 27: 28-34.
17. Mohammed S.I., Mikhael E.M., Ahmed F.T. et al. Risk factors for occurrence and recurrence of diabetic foot ulcers among Iraqi diabetic patients. Diabetic Foot & Ankle. 2016; 7: 1-6.
18. Bakri F.G., Allan A.H., Khader Y.S. et al. Prevalence of Diabetic Foot Ulcer and its Associated Risk Factors among Diabetic Patients in Jordan. J Med J. 2012; 46(2): 118-125.
19. Shashanka R., Rajanna B. Bacteriological Profile of Diabetic Foot Ulcers: A Clinical Study. IJSS Journal of Surgery. 2016; 2(3): 38-41.
20. Hefni A., Al-Metwally R., Attia K.M. et al. Bacteriological study of diabetic foot infection in Egypt. J Arab Soc Med Res. 2013; 8: 26-32.
21. Mehraj M. A review of Wagner classification and current concepts in management of diabetic foot. International Journal of Orthopaedics Sciences. 2017; 4(1): 933-935.
22. Lipsky B.A., Berendt A.R., Cornia P.B. et al. Infectious diseases society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clinical Infectious Disease. 2012; 54 (12): 132 173.
23. Shahi S., Kumar A., Kumar S. et al. Prevalence of Diabetic Foot Ulcer and Associated Risk Factors in Diabetic Patients From North India. The Journal of Diabetic Foot Complications. 2012; 4(3): 83-91.
24. Shanmugam P., Jeya M., Susan L. The Bacteriology of Diabetic Foot Ulcers, with a Special Reference to Multidrug Resistant Strains. Journal of Clinical and Diagnostic Research. 2013; 7(3): 441-445.
25. Ahmad A., Asif K., Saleem M. et al. A Study of Risk Factors of Diabetic Foot Ulcers. Pakistan Journal of Medical and Health Sciences, 2017; 11(1): 174-176.
26. Bhaktavatsalam M., Chavan M. Prevalence and risk factors of diabetic foot ulcer at a tertiary care hospital among diabetic patients. Int J Adv Med. 2018; 5(5): 1274-1279.
27. Khan H., Khan Z., Khan, I. et al. Factors contributing to the development of diabetic foot ulcers and role of health literacy. Rawal Medical Journal. 2018a; 36(1): 34-37.
28. Ahmed A., Algamdi S., Algurashi A. et al. Risk factors for diabetic foot ulceration among patients attending primary health care services. The Journal of Diabetic Foot Complications. 2014; 6(2): 40-47.
29. Anand A., Biswal I., Soni R. et al. A clinico-microbiological study of diabetic foot ulcer patients to identify risk factors and their correlation with prognosis in tertiary care hospital in India. Int Surg J. 2016; 3(2): 669-673.
30. Nongmaithem M., Bawa A., Pithwa A. et al. A study of risk factors and foot care behavior among diabetics. J Family Med Prim Care. 2016; 5(2), 399- 403.
31. Madmoli M., Karami M. Madmoli Y. Some Effective Risk Factors on Diabetic Foot Ulcer: Study on 2643 Cases of Patients with Diabetes. Journal of Research in Medical and Dental Science. 2019; 7(3): 139-143.
32. AL-Shammaree S.A., Abu-ALkaseem B.A., Salman I.N. Procalcitonin levels and other biochemical parameters in patients with or without diabetic foot complications. J Res Med Sci. 2017; 1-5.
33. Alizadeh S., Beige Z.B., Poor S.A. et al. Study of Serum Thrombospondin-1 Level in Diabetic Patients with Diabetic Foot Ulcer. Journal of Molecular Pathology and Biochemistry. 2019; 1(102): 1-5.
34. Jafari N.J., Firouzabadi M.S., Izadi M. et al. Can Procalcitonin Be an Accurate Diagnostic Marker for the Classification of Diabetic Foot Ulcers?. International Journal of Endocrinology and Metabolism. 2014; 12(1): 1-6.