Association Between Smoking and Foot Ulcer among Patients with Diabetes Mellitus, Wad Medani, Sudan
Background: This study aimed to assess the relationship between smoking and diabetic foot ulcer (DFU) among adult diabetic patients presenting to Aldarga Diabetic Center, Wad Medani, Sudan in 2020.
Methods: This comprehensive study is based on primary data obtained via a longitudinal cross-section random sample of 400 patients with diabetes mellitus who presented to Aldarga Diabetic Health Center in Wad Medani Town, Gezira State, Sudan between September and December 2020. Data were collected using a structured questionnaire. The core questions included two main dimensions: sociodemographic variables and smoking. Data were analyzed using the SPSS software, v.20, using descriptive and inferential statistics, namely, frequency tables and graphs, showing the Chi-square test of the relationship between the dependent and the independent variables.
Results: Of the 400 participants, 96 were clearly diagnosed with foot ulcer giving a proportion of 33% in the sample. There was a statistically significant relationship between smoking and DFU. A Chi-square test was done to measure the relationship between smoking and foot ulcer, which was significant at P = 0.043.
Conclusion: Extensive awareness programs to control the negative effect of smoking in accelerating DFU and amputation are necessary.
prevalence of diabetic foot ulcer, diabetic, diabetic food ulceration, smoking
 International Diabetes Federation (IDF). (2019). IDF Diabetes Atlas (9th ed.). IDF.
 Alexiadou, K. and Doupis, J. (2012). Management of diabetic foot ulcers. Diabetes Therapy, vol. 3, article 4.
 Dubský, M., Jirkovská, A., Bem, R., et al. (2013). Risk factors for recurrence of diabetic foot ulcers: prospective follow-up analysis in the Eurodiale subgroup. International Wound Journal, vol. 10, no. 5, pp. 555–561.
 Al Busaidi, N., Shanmugam, P., and Manoharan, D. (2019). Diabetes in the Middle East: government health care policies and strategies that address the growing diabetes prevalence in the Middle East. Current Diabetes Reports, vol. 19, no. 2, p. 8.
 Rigato, M., Pizzol, D., Tiago, A., et al. (2018). Characteristics, prevalence, and outcomes of diabetic foot ulcers in Africa. A systemic review and meta-analysis. Diabetes Research and Clinical Practice, vol. 142, pp. 63–73.
 Elmadhoun, W. M., Noor, S. K., Ibrahim, A. A., et al. (2016). Prevalence of diabetes mellitus and its risk factors in urban communities of north Sudan: population-based study. Journal of Diabetes, vol. 8, no. 6, pp. 839–846.
 Almobarak, A. O., Awadalla, H., Osman, M., et al. (2017). Prevalence of diabetic foot ulceration and associated risk factors: an old and still major public health problem in Khartoum, Sudan? Annals of Translational Medicine, vol. 5, no. 17, p. 340.
 Fu, X.-L., Ding, H., Miao, W.-W., et al. (2018). Association between cigarette smoking and diabetic foot healing: a systematic review and meta-analysis. The International Journal of Lower Extremity Wounds, vol. 17, no. 4, pp. 247–257.
 Taha, A. and Ball, K. (1982). Smoking in Africa: the coming epidemic. World Smoking Health, vol. 7, no. 2, pp. 25–30.
 Kish, L. (2004). Statistical design for research. John Wiley & Sons, Inc.
 Netten, J. J., Bus, S. A., Apelqvist, J., et al. (2020). Definitions and criteria for diabetic foot disease. Diabetes/Metabolism Research and Reviews, vol. 36, no. S1.
 Henningfield, J., Rose, C. A., Sweanor, D. T., et al. (2020). Smoking. Encyclopedia Britannica. Retrieved from: https://www.britannica.com/topic/smoking-tobacco
 Xia, N., Morteza, A., Yang, F., et al. (2019). Review of the role of cigarette smoking in diabetic foot. Journal of Diabetes Investigation, vol. 10, no. 2, pp. 202–215.
 Pal, B., Raveender, N., and Sudipta, P. (2016). A study on the impact of smoking and alcoholism as determinant factors in the prognosis and outcome of diabetic foot ulcer disease. International Journal of Research in Medical Sciences, vol. 4, no. 5, pp. 1720–1724.
 Liu, M., Zhang, W., Yan, Z., et al. (2018). Smoking increases the risk of diabetic foot amputation: a meta-analysis. Experimental and Therapeutic Medicine, vol. 15, pp. 1680–1685.