Risk Factors and Outcome of Patients with Diabetic Foot Ulcers

Background and objective

Diabetic foot ulcers result from a combination of vasculopathy, neuropathy and infections. The present study was aimed at identifying the demographics, clinical and biochemical risk factors for development of foot ulcer in diabetic subjects and their association with the macro and micro-vascular complications of Diabetes.The outcomes with respect to healing and requirement of amputation were also studied.

Methods

This was a cross sectional study conducted at a charitable tertiary care centre over a period of 18 months. Patients witha diabetic foot ulcer that had not healed for more than 14 days (n=106) were included in the study. Diabetic patients with pressure sores (bed ridden patients) and with major trauma causing ulcers were excluded from the study. Patients who failed to follow up were also excluded from the analysis. All patients were initially examined in detail clinically and evaluated for micro and macro vascular complications of diabetes and followed up for wound outcomes.

Results

In this study, diabetic foot ulcers were found in the 5th decade and men were affected more often than women. Ischemic heart disease and Cerebro-vascular accidents were present in 36.7% and 18.9 % and Retinopathy and Nephropathy were present in 19.8 % and 43.4% patients respectively. Deep, infected ulcers were associated with increased incidence of non-healing, greater number of amputations and higher mortality. The highest mortality (53.8%) was seen in smokers and alcoholics. Increased WBC count, raised creatinine, proteinurea and high HbA1c were associated with amputations and mortality. On Binary multiple logistic regression analysis it was found that duration of diabetes, stage of diabetic ulcer, diabetic nephropathy and diabetic retinopathy were independent predictors of ulcer healing and mortality.