Authors (including presenting author) :
Suen GKV (1), Chan PF (1), Lai KPL (1), Luk MHM (1), Fung HT (1)
Affiliation :
1. Department of Family Medicine and Primary Health Care, Kowloon East Cluster (KEC)
Introduction :
Diabetes mellitus is a major global health issue which can cause a wide range of complications. One of the most devastating complications is infected foot ulcer requiring lower limb amputation. Diabetic neuropathy - leading to loss of protective sensation and/or deformity, and peripheral vascular disease are major predisposing conditions which increase the risk of development of foot ulcer. This study was carried out to evaluate the prevalence of patients with type 2 diabetes who were identified at risk of developing foot ulcer – “diabetic foot at-risk”, and the associated factors. The results would provide important information about the current situation of diabetic foot at-risk for devising strategies in prevention of diabetic foot ulcer disease in primary care.
Objectives :
To evaluate the prevalence and associated factors of diabetic foot at-risk in Chinese patients with type 2 diabetes in primary care.
Methodology :
A cross-sectional study was performed on all Chinese adult patients who attended for diabetic complication assessment during the period from 1st July 2019 to 30th June 2022 in all KEC General Out-patient Clinics. Data were collected from computerized consultation and diabetic complication assessment records for statistical analysis. The primary outcome was the prevalence of diabetic foot at-risk, based on the International Working Group on the Diabetic Foot (IWGDF) 2019 Risk Stratification System, which outlined the risk of ulcer development. The secondary outcome was the associated factors of diabetic foot at-risk.
Result & Outcome :
37,359 patients were included in this study. Mean age of patients was 66.6± 10.7 years old. 52.8% of patients were female. The mean duration of diabetes was 7 years. 7.6% of diabetic patients were found to have diabetic foot at-risk. 4.3%, 3.2% and 0.1% patients belonged to IWGDF diabetic foot risk category 1 (low), 2 (moderate) and 3 (high) respectively. 0.2% had active foot ulcer disease. Male (OR 1.99), older age (OR 1.10), current smoker (OR 1.25), ex-smoker (OR 1.15), obesity (OR 1.14), HbA1c more than 7% (OR 1.14 – 2.00), presence of diabetic retinopathy (OR 1.37), presence of albuminuria or proteinuria (OR 1.47) were found to have significant positive association with diabetic foot at-risk. Regular physical activity of moderate intensity (OR 0.83), taking lipid-lowering drug (OR 0.87) were found to have significant negative association. In conclusion, diabetic foot at-risk was not uncommon in our patients. Optimization of the control of modifiable risk factors, and focus on management of pre-ulcerative condition for at-risk patients should be adopted to prevent the development of foot ulcer.
