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evaluation of foot at risk among diabetic patients using diabetic foot ...
Transcript of 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300 major amputation per year in Kuantan HTAA Hospital Unpublished data HTAA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
REFERENCES 1. Adler, A. I., et al. (1997). Risk factors for diabetic peripheral sensory neuropathy: results of the Seattle Prospective Diabetic Foot Study. Diabetes care 20(7): 1162-1167. 2. Boulton, A. J. M., et al. (2005). The global burden of diabetic foot disease. The Lancet 366(9498): 1719-1724. 3. Gregg, E. W., et al. (2004). Prevalence of lower-extremity disease in the US adult population≥ 40 years of age with and without diabetes. Diabetes Care 27(7): 1591-1597. 4. Grenon, S. M., et al. (2009). Ankle–Brachial Index for Assessment of Peripheral Arterial Disease. New England Journal of Medicine 361(19). 5. Kamei, N., et al. (2005). Effectiveness of Semmes-Weinstein monofilament examination for diabetic peripheral neuropathy screening. Journal of Diabetes and its Complications 19(1): 47-53. 6. Letchuman, G., et al. (2010). Prevalence of Diabetes in the Malaysian National Health Morbidity Survey III 2006. Med J Malaysia 65(3): 173. 7. Mimi, O., et al. (2003). The prevalence of diabetic peripheral neuropathy in an outpatient setting. The Medical journal of Malaysia 58(4): 533. 8. Ministry of Health Malaysia (2004). Clinical Practice Guidelines for Management of Diabetic Foot. 9. Nather, A., et al. (2008). Epidemiology of diabetic foot problems and predictive factors for limb loss. Journal of Diabetes and its Complications 22(2): 77-82. 10. Nather, A., et al. (2008). Assessment of sensory neuropathy in diabetic patients without diabetic foot problems. Journal of Diabetes and its Complications 22(2): 126-131. 11. Nather A. et al. (2010). Foot screening for diabetics. Ann Acad Med Singapore. 39(6):472-5 12. Palumbo, P. J. and L. J. Melton III (1995). Peripheral vascular disease and diabetes. Diabetes in America 2: 401-408. 13. Peters, E. J. G. and L. A. Lavery (2001). Effectiveness of the diabetic foot risk classification system of the International Working Group on the Diabetic Foot. Diabetes care 24(8): 1442-1447. 14. Pham, H., et al. (2000). Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. Diabetes Care 23(5): 606-611. 15. Rabia, K. and E. Khoo (2007). Prevalence of peripheral arterial disease in patients with diabetes mellitus in a primary care setting. Medical journal of malaysia 62(2): 130.