evaluation of foot at risk among diabetic patients using diabetic foot ...

EVALUATION OF FOOT AT RISK AMONG DIABETIC PATIENTS

USING DIABETIC FOOT ASSESSMENT PROTOCOL

Aminudin Che Ahmad, MS Orth, MD Nurfatihah Alias, MBBS

Nor Adila Abdul Aziz, MBBS Nurul Farhana Mustafa, MBBS

International Islamic University Malaysia, Kuantan, Pahang, MALAYSIA

Evaluation of Foot at Risk Among Diabetic Patients Using Diabetic Foot Assessment

Protocol

Aminudin Che Ahmad

My disclosure is in the Final AOFAS Mobile App.

I have no potential conflicts with

this presentation.

Introduction

15% of diabetic patient will develop lower extremity ulcer Palumbo et al. 1995

25% of diabetic patient has risk for foot ulcer Armstrong et. al, 2003

In Singapore, 28.8% of diabetic foot screened are at risk foot Nather et. al, 2010

300 major amputation per year in Kuantan HTAA Hospital Unpublished data HTAA

2011

Objectives

To assess foot of diabetic patients and to determine foot at risk based on King’s Classification

Specific Objectives

1. To study the demographic patterns of diabetic patients presented in Kuantan, Pahang.

2. To assess the predictive factors of diabetic foot complications based on standard diabetic foot screening tests.

Methodology

Cross-sectional study

Sampling method-Convenience sampling

a designated standardized foot assessment protocol

performed in 200 diabetics (397 feet)

from 16th July 2012 until 18th August 2012

HTAA KK Beserah

569 diabetic patients (2011)

2223 diabetic patients (June 2012)

Data collection

224 diabetic patients were approached

24 patients refuse to

participate

Drop from study

200 patients agree to

participate

Data collection (questionnaire)

(n=200 patients)

Foot assessment

(n=397 feet)

3 feet cannot be assessed due to major amputation

Eligible for ABSI measurement

(n=382 feet)

COMPLETE

Exclusion from ABSI measurement

(n=15 feet)

5 feet : wound/pain at leg

10 feet : unable to take blood pressure at one of the arm

(5 patients)

COMPLETE

King’s classification

STAGE DEFINITION

Stage 1 (normal foot) No risk factors of neuropathy, ischemia, callus, deformity, swelling

Stage 2 (foot at risk) 1 or more risk factors including ischemia, neuropathy, callus, deformity or swelling.

Stage 3 (ulcerated foot) Skin breakdown of the foot

Stage 4 (infected foot) Infected foot

Stage 5 (necrotic foot) Necrosis of the foot

Stage 6 (unsalvageable foot) Foot that cannot be saved and need major amputation

Diabetic foot screening form

1st part: history of diabetes, medical history

2nd part: foot assessment (dermatology, neurology, vascular)

Mean (SD)

Age (years) 57.5 (10.9)

n (%)

Gender Male 122 (61.0)

Female 78 (39.0)

Race Malay 169 (84.5)

Chinese 23 (11.5)

Indian 8 (4.0)

Education level No formal education 14 (7.0)

Primary level 63 (31.5)

Secondary level 97 (48.5)

Tertiary level 26 (13.0)

Occupation Government sector 17 (8.5)

Private sector 26 (13.0)

Self-employed 37 (18.5)

Retired/ housewife/ unemployed/ student

120 (60.0)

n (%)

Monthly household income

≤ RM 750.00 71 (35.5)

> RM 750.00 129 (64.5)

Smokers 62 (31.0)

Alcohol consumption 6 (3.0)

Diabetic status New case 12 (6.0)

Known case 188 (94.0)

Duration of diabetes mellitus

≤ 10 years 146 (77.7)

> 10 years 42 (22.3)

Treatment of diabetes mellitus

Diet alone 8 (4.0)

Oral hypoglycemic agent

112 (56.0)

Insulin 34 (17.0)

Combined 46 (23.0)

SOCIODEMOGRAPHIC CHARACTERISTIC (n=200 patients)

37.8

57.7

2.3 1.7 0.5

Stage 1 Stage 2 Stage 3 Stage 4 Stage 5

FOOT AT RISK

In study done in Singapore; 28.8% of diabetic feet being screened was categorized as Stage 2: foot at risk

(Nather et al. 2010)

In our study, the prevalence of neuropathy in duration of ≥10 years of diabetes mellitus was SIGNIFICANTLY HIGHER (59.5%) compare to <10 years duration (36.1%) with p-value <0.001

There was also marked increase in neuropathy detected in patients with more than 10 years duration of diabetes mellitus

Kamei, Yamane et al. 2005

41.3

5.2

26.7 8.1 13.1

020406080

100

Yes No

50.7% of 134 diabetic patients in Primary Care Clinic, Hospital Kuala Lumpur has peripheral neuropathy

(Mimi, Teng et al. 2003)

Foot at Risk

Comparing all feet vs foot at risk :

1. Peripheral neuropathy (41.3% and 65.1%)

2. Corns and calluses (26.7% and 45.0%)

3. Foot deformity (13.1% and 21.9%)

4. PAOD (8.9% and 11.1%)

5. Foot swelling (8.1% and 8.3%)

proven to be persistently higher in foot at risk

Conclusion

Prevalence of foot at risk is alarming (57.9%).

Need proper intervention:

1. to delay the feet from progressing to worse complications.

2. with proper foot assessment annually or more frequent interval during routine examination at clinics.

3. by well trained diabetic care personnel

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