The objective was to determine the association between a diabetes mellitus duration greater than 10 years and the severity of diabetic foot in hospitalized patients in Latin America.
Analytical, observational, and retrospective study based in secondary databases. Patients older than 18 years with diagnosis of diabetes mellitus (DM) and hospitalized for any causes were included. The independent and dependent variables were having more than 10 years of diagnosis of DM and the severity of the diabetic foot disease (Wagner> = 2), respectively. A crude Poisson regression analysis was performed to obtain prevalence rates adjusted to confounders.
Male gender was 54.8% and the median age was 62 years. In the group with more than10 years of disease (n = 903) 18% (n = 162) had severe injuries. We performed two Poisson regression analyzes, one of which included the entire sample; and in the other, only patients with some degree of ulcer were included at the time of evaluation (Wagner > = 1). In the first analysis the PR was 1.95 (p < 0.01) adjusted for the significant variables in the bivariate analysis and in the second analysis the PR was 1.18 (p < 0.01) adding to the adjustment the days of injury prior to hospitalization and the location of the ulcer.
We conclude that in patients with more than 10 years of diabetes mellitus, diabetic foot injuries are more severe, regardless type of diabetes, gender, age, history of amputation and days of injury prior to hospitalization for inpatients in Latin America.
SchaperNCNettenJJApelqvistJ, et al. Practical guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36(1):e3266. Accessed March 26, 2020.https://onlinelibrary.wiley.com/doi/abs/10.1002/dmrr.3266
2.
ZhangPLuJJingYTangSZhuDBiY. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017;49(2):106‐116. Accesed March 26, 2020.https://pubmed.ncbi.nlm.nih.gov/27585063/
3.
TrianaR. Diabetic foot. Pathophysiology and consequences. Rev Col Or2014;28(4):143‐153.
4.
QuispeYManriqueHSaénzS,et al.Manual de recomendaciones de la Alianza para el Salvataje del Pie Diabético Perú para el manejo de pacientes con diabetes y pie diabético frente al COVID-19. Published April 2020. Accessed April 2020. Available online: https://d-foot.org/images/manual-alpie-peru.pdf
5.
Damas-CasaniVAYovera-AldanaMSeclen SantistebanS. Classification of foot at risk of ulceration according to the IWGDF system and associated factors in patients with type 2 diabetes mellitus from a Peruvian hospital. Rev Med Hered. 2017;28(1):5.Accesed March 26, 2020.http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1018-130X2017000100002
6.
CavanaghPAttingerCAbbasZBalARojasNXuZR. Cost of treating diabetic foot ulcers in five different countries. Diabetes Metab Res Rev. 2012;28(1):107‐111. Accesed March 26, 2020.https://pubmed.ncbi.nlm.nih.gov/22271734/
7.
ArmstrongDGSwerdlowMAArmstrongAAConteMSPadulaWVBusSA. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res. 2020;13(1):16Accesed March 26, 2020.https://pubmed.ncbi.nlm.nih.gov/32209136/
KhalfallahMGoutaELDougazW, et al. Predictive factors for major amputation of lower limb in diabetic foot: about 430 patients. Tunis Med. 2018;95(5):298‐301. Accessed March 26, 2020.https://pubmed.ncbi.nlm.nih.gov/30430504/
10.
GurneyJKStanleyJRumball-SmithJYorkSSarfatiD. Postoperative death after lower-limb amputation in a national prevalent cohort of patients with diabetes. Dia Care. 2018;41(6):1204‐1211.
11.
MoonK-CKimK-BHanS-KJeongS-HDhongE-S. Risk factors for Major amputation on hindfoot ulcers in hospitalized diabetic patients. Adv Wound Care. 2019;8(5):177‐185. Accessed March 26, 2020.https://pubmed.ncbi.nlm.nih.gov/31737413/
12.
NarresMKvitkinaTClaessenH, et al. Incidence of lower extremity amputations in the diabetic compared with the non-diabetic population: a systematic review. PLoS ONE. 2017;12(8):e0182081. Accessed March 26, 2020.https://pubmed.ncbi.nlm.nih.gov/28846690/
13.
WagnerFW. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle. 1981;2(2):64‐122. doi:10.1177/107110078100200202
14.
SantemaTBLenselinkEABalmRUbbinkDT. Comparing the meggitt-wagner and the university of texas wound classification systems for diabetic foot ulcers: inter-observer analyses: inter-observer analyses of two wound classification systems for diabetic foot ulcers. Int Wound J. 2016;13(6):1137‐1141. Accessed March 26, 2020.https://pubmed.ncbi.nlm.nih.gov/25720543/
15.
Ministry of Health. Technical guide to clinical practice for diagnosis, treatment and control of diabetic foot. Accessed March 28, 2020. http://bvs.minsa.gob.pe/local/MINSA/3971.pdf.
16.
MonteiroMMartinDVazASampaioSDinisM. Classification systems for lower extremity amputation prediction in subject with active diabetic foot ulcer: a systematic review and meta-analysis. Diabetes Metab Res Rev. 2014;30(7):610‐622. https://pubmed.ncbi.nlm.nih.gov/24523130/
17.
Byung-JoonJHwan JunCJin seokKMin SungTEun SooP. Comparison of five systems of classification of diabetic foot ulcers and predictive factors for amputation. Int Wound J. 2017;14(3):537‐545. Accessed March 28, 2020.https://pubmed.ncbi.nlm.nih.gov/27723246/
18.
TaburSErenMÇelikY, et al. The major predictors of amputation and length of stay in diabetic patients with acute foot ulceration. Wien Klin Wochenschr. 2015;127(1–2):45‐50. Accessed March 28, 2020.https://pubmed.ncbi.nlm.nih.gov/25398288/
19.
BravoALinaresJVeraBSalmerónLRosE. Inter-observer agreement of the wagner, universitiy of texas and PEDIS classification systems for the diabetic foot syndrome. Foot Ankle Surg. 2018;24(1): 60‐64. Accessed March 28, 2020.https://pubmed.ncbi.nlm.nih.gov/29413776/
20.
SayinerZCanFAkarsuE. Patients’ clinical characteristics and predictors for diabetic foot amputation. Prim Care Diabetes. 2019;13(3):247‐251. Accessed March 28, 2020.https://pubmed.ncbi.nlm.nih.gov/30600172/
21.
Al-RubeaanKAl DerwishMOuiziS, et al. Diabetic foot complications and their risk factors from a large retrospective cohort study. PLoS One. 2015;10(5):e0124446. Accessed March 28, 2020.https://pubmed.ncbi.nlm.nih.gov/25946144/
22.
HuangZHLiSQKouYHuangLYuTHuA. Risk factors for the recurrence of diabetic foot ulcers among diabetic patients: a meta-analysis. Int Wound J. 2019;16(6):1373‐1382. Accessed March 28, 2020.https://pubmed.ncbi.nlm.nih.gov/31489774/
23.
ArribasplataYLunaC. Risk factors associated with diabetic foot at luis N. Saenz hospital. Rev Fac Med Hum. 2019;19(2):75‐81 doi:10.25176/RFMH.v19.n2.2070
24.
CrawfordFCezardGChappellFM, et al. A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS). Health Technol Assess. 2015;19(57):1‐210. Accessed March 28, 2020.https://pubmed.ncbi.nlm.nih.gov/26211920/
25.
Monteiro-SoaresMBoykoEJRibeiroJRibeiroIDinis-RibeiroM. Predictive factors for diabetic foot ulceration: a systematic review. Diabetes Metab Res Rev. 2012;28(7):574‐600. Accessed March 28, 2020.https://pubmed.ncbi.nlm.nih.gov/22730196/
26.
XuLZengHZhaoJ, et al. Index of plantar pressure alters with prolonged diabetes duration. Diabetes Ther. 2019;10(6):2139‐2152. Accessed March 28, 2020.https://pubmed.ncbi.nlm.nih.gov/31595458/
27.
KovacBKovacBMarusić-EmediSSvalinaSDemarinV. Clinical and electrophysiological signs of diabetic polyneuropathy: effect of glycemia and duration of diabetes mellitus. Acta Clin Croat. 2011;50(2):149‐157.
28.
CarroGVSaurralRSangüezFSWitmanEL. Diabetic foot among hospitalized patients in latin america. Medicina (Buenos Aires). 2018;78(4):243‐251.
29.
AbdulghaniHMAlRajehASAlSalmanBH, et al.Prevalence of diabetic comorbidities and knowledge and practices of foot care among diabetic patients: a cross-sectional study. Diabetes Metab Syndr Obes. 2018;11(11):417‐425.
30.
AlmobarakAOAwadallaHOsmanMAhmedMH. Prevalence of diabetic foot ulceration and associated risk factors: an old and still major public health problem in Khartoum, Sudan?. Ann Transl Med. 2017;5(17):340.
31.
Di LorenziRBrunoLGarauMJavielGRuizM. Prevalence of peripheral neuropathy in diabetes unit. Rev Urug Med Int. 2020;5(2):17‐27.
32.
OgberaAAdeleyeOSolagberuBAzenaborA. Screening for peripheral neuropathy and peripheral arterial disease in person with diabetes mellitus in a Nigerian university teaching hospital. BMC Res Notes. 2015; 8(8):533.
33.
AguileraRDíazEColmanBCarranzaRPadillaJCáceresG. Peripheral arterial disease and diabetes mellitus type 2 in the primary care. Rev Cubana Angiol Cir Vasc. 2020; 21(2):1–16.
34.
RobinsonLRStolovWCRubnerDEWahlPWLeonettiDLFujimotoWY. Height is an independent risk factor for neuropathy in diabetic men. Diabetes Res Clin Pract. 1992;16(2):97‐102.
35.
NúñezDMartinellaICruzRMourlotRGarcíaV. Clinical epidemiological characterization of patients affected by diabetic foot. Rev Cuba Med Mil. 2017;46(4):337–348.
36.
Chaparro DiazLMendoza-CatalánG, Carreño moreno S y gutiérrez-valverde JM. How men perceive having type 2 diabetes mellitus: cases in bogota. Investig Enferm Imagen Desarro. 2016;1(3):7.
37.
Rodríguez-SantamaríaYJuárez-MedinaLLZúñiga-VargasMLCadena-SantosFMendoza-CatalánG. Type 2 diabetes mellitus among men: psychological factors influencing self-care efficacy. Enferm Univ. 2020;17(1): 28‐31.
38.
Navarro-PeternellaFMLopesAPde ArrudaGTestonEFMarconSS. Differences between genders in relation to factors associated with risk of diabetic foot in elderly persons: a cross-sectional trial. J Clin Transl Endocrinol. 2016;6(6):30‐36.
39.
MatuteCGuillermoAMatuteJFernándezEPerdomoR. Diabetic foot and complications. Arch de Medicina. 2016;12(3):7.
40.
TongTYangCTianY,et al.Phenotypes and outcomes in middle-aged patients with diabetic foot ulcers: a retrospective cohort study. J Foot Ankle Res. 2020;13(24):1–8.
41.
MárquezSZonanaAAnzaldoMMuñozJ. Diabetic foot risk in patients with type II diabetes mellitus in a family medicine unit. SEMERGEN – Medicina de Familia. 2014;40(4):183‐188.
42.
CardonaDVinentLCalaJZaldivarERodríguezA. Risky feet in patients with diabetes mellitus type 2 in the primary health care during 2016. MEDISAN. 2018; 22(5).
43.
RomeroGMCSándezLM. Evolution of the diabetic foot graded 4 and 5 in wagner’s classification scale. Rev Cubana Angiol Cir Vasc. 2017;18(1):71‐81.
44.
FalzonBFormosaCCamilleriLGattA. Duration of type 2 diabetes is a predictor of elevated plantar foot pressure. Rev Diabet Stud. 2018;14(4):372‐380.
45.
DreyfusJGayleJTruemanPDelhougneGSiddiquiA. Assessment of risk factors associated with hospital-acquired pressure injuries. Am J Med Qual. 2017;33(4): 348‐358.
46.
FabeloMAFigueroaMAValdésPCPérezLDÁlvarezLA. Evolution of diabetic foot ulcers with the mixed treatment of heberprot-P® and ozone therapy. Rev Cubana Angiol Cir Vasc. 2019;20(1):1‐15.
47.
ToscanoCMSugitaTHRosaMQMPedrosaHCRosaRDSBahiaLR. Annual direct medical costs of diabetic foot disease in Brazil: a cost of illness study. Int J Environ Res Public Health. 2018;15(1):89.
48.
Monteiro-SoaresMBoykoEJJeffcoateW, et al. Diabetic foot ulcer classifications: a critical review. Diabetes Metab Res Rev. 2020;36Suppl 1:e3272. doi:10.1002/dmrr.3272
49.
GameF. Classification of diabetic foot ulcers. Diabetes Metab Res Rev. 2016; 32Suppl 1:186‐194. doi:10.10027dmrr.2746
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
