PREVALENCE OF RISK PREVALENCE OF RISK FACTORS FOR DIABETIC FACTORS FOR DIABETIC FOOT ULCER AND RISK FOOT ULCER AND RISK STRATIFICATION IN TYPE 2 STRATIFICATION IN TYPE 2 DIABETES DIABETES DR. NEETA DESHPANDE DR. NEETA DESHPANDE ASSOCIATE PROF.,JN ASSOCIATE PROF.,JN MEDICAL COLLEGE AND KLE MEDICAL COLLEGE AND KLE HOSPITAL, BELGAUM HOSPITAL, BELGAUM
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PREVALENCE OF RISK PREVALENCE OF RISK FACTORS FOR DIABETIC FACTORS FOR DIABETIC FOOT ULCER AND RISK FOOT ULCER AND RISK
STRATIFICATION IN TYPE 2 STRATIFICATION IN TYPE 2 DIABETESDIABETES
DR. NEETA DESHPANDEDR. NEETA DESHPANDEASSOCIATE PROF.,JN MEDICAL ASSOCIATE PROF.,JN MEDICAL COLLEGE AND KLE HOSPITAL, COLLEGE AND KLE HOSPITAL,
BELGAUMBELGAUM
INTRODUCTIONINTRODUCTION40-70% of LL amputations related to 40-70% of LL amputations related to DMDMSubstantial emotional, physical and Substantial emotional, physical and financial lossesfinancial lossesIlliteracy, lack of knowledgeIlliteracy, lack of knowledgeLargely preventable through early Largely preventable through early detection of “high-risk” feet, detection of “high-risk” feet, preventive footwear and counselingpreventive footwear and counseling
AIMS AND OBJECTIVESAIMS AND OBJECTIVESTo know prevalence of risk factors for To know prevalence of risk factors for diabetic foot ulceration and diabetic foot ulceration and stratification into risk categoriesstratification into risk categoriesTo correlate risk categories to age, To correlate risk categories to age, duration of DM, glycemic control and duration of DM, glycemic control and SESSES
INCLUSION CRITERIAINCLUSION CRITERIA
All known cases of type 2 DM of more All known cases of type 2 DM of more than 1 year durationthan 1 year duration
EXCLUSION CRITERIAEXCLUSION CRITERIAPatients with current foot ulcerPatients with current foot ulcerPatients of DM admitted for other Patients of DM admitted for other neurological causesneurological causes
METHODOLOGYMETHODOLOGY215 type 2 diabetics who were willing 215 type 2 diabetics who were willing to participate in the study were to participate in the study were questioned in detail – age, duration of questioned in detail – age, duration of diabetes, footwear practices, level of diabetes, footwear practices, level of education, symptoms of neuropathy, education, symptoms of neuropathy, vasculopathy, previous foot vasculopathy, previous foot ulcer/amputationulcer/amputationThorough foot examination was doneThorough foot examination was doneBlood sample was collected for HbA1cBlood sample was collected for HbA1c
Definitions of recorded dataDefinitions of recorded dataHISTORY OF FOOT ULCER – Healed HISTORY OF FOOT ULCER – Healed foot ulcer of more than 3 months foot ulcer of more than 3 months durationdurationHISTORY OF LL AMP – Non-traumatic HISTORY OF LL AMP – Non-traumatic amp at any level in the LLamp at any level in the LLPAD – Intermittent claudication or h/o PAD – Intermittent claudication or h/o reconstructive vascular surgery reconstructive vascular surgery and/or absence of foot pulsesand/or absence of foot pulses
Definitions of recorded data - contdDefinitions of recorded data - contdSENSORY NEUROPATHY - SENSORY NEUROPATHY - > > 1 “no 1 “no response” to 10 g MF applied to 10 response” to 10 g MF applied to 10 sites (9 plantar and 1 dorsal) and/or sites (9 plantar and 1 dorsal) and/or NDSNDSFOOT DEFORMITY – hallux valgus, FOOT DEFORMITY – hallux valgus, overlapping toes, fixed clawed toes, overlapping toes, fixed clawed toes, pes cavus/planus, Charcot foot, pes cavus/planus, Charcot foot, prominent metatarsal headsprominent metatarsal heads
NEUROPATHY DISABILITY NEUROPATHY DISABILITY SCORE – RIGHT AND LEFTSCORE – RIGHT AND LEFT
VibrationVibration sense sense (dorsum of big toe) : (dorsum of big toe) : Present=0, Present=0, reduced/absent=1reduced/absent=1Pin prickPin prick : : Present=0, Present=0, reduced/absent=1reduced/absent=1Ankle jerkAnkle jerk : : present=0, present present=0, present on reinforcement=1,on reinforcement=1,
absent=2absent=2
TOTAL SCORE:TOTAL SCORE:
3-4 Mild neuropathy3-4 Mild neuropathy
5-7 Moderate5-7 Moderate
8-10 Severe8-10 Severe
CLASSIFICATION OF INTERNATIONAL CLASSIFICATION OF INTERNATIONAL WORKING GROUP ON DIABETIC FOOTWORKING GROUP ON DIABETIC FOOT
Graph showing Percentage of patients of different glycemic control in each group distribution
Good Fair Poor
Barefoot walkingBarefoot walking
42
5870
30
83
17
100
00
20
40
60
80
100
Per
cent
age
Group 0 Group 1 Group 2 Group 3
Graph showing Percentage of Bare foot walkers in each group distribution
Present Absent
Level of educationLevel of education
44 45 4349
3219
75
178
100
0 00
20
40
60
80
100
Per
cent
age
Group 0 Group 1 Group 2 Group 3
Graph showing level of Education in group
Iliterate Schooling College
ConclusionsConclusionsOverall prevalence of neuropathy is higher Overall prevalence of neuropathy is higher than vasculopathy (38.6% Vs 10.2%)than vasculopathy (38.6% Vs 10.2%)Age (p<0.01), duration of diabetes Age (p<0.01), duration of diabetes (p<0.001) and glycemic control (p<0.001) and glycemic control (p<0.01)are significantly correlated to (p<0.01)are significantly correlated to high-risk feethigh-risk feetBarefoot walking (p<0.001) and level of Barefoot walking (p<0.001) and level of education (p<0.0002) are important risk education (p<0.0002) are important risk factors factors