Implementation of Diabetic Foot Risk Assessment (Diafora) Score to Study Diabetic Foot and Predict Amputation: An Indian Perspective

Abstract

BACKGROUND-Diabetic foot is a wound failing to heal after 4 weeks of onset which can result from trauma, peripheral arterial disease and/or sensory neuropathy affecting the feet in diabetes mellitus. METHODS- With that background we aim to predict the functionality of a relatively new score called DIAFORA in the North Indian population, by studying parameters like neuropathy, presence of foot deformity, peripheral arterial disease, multiple ulcers, infection, gangrene, bone involvement along with blood sugar levels and culture results. We classified patients with diabetic foot into 3 risk groups- low risk, medium risk and high risk to predict lower limb amputation. RESULTS-With a 41:8 male-female ratio, our study subject’s mean age was 55.38+/- 11 years. Examining patients 90 days post enrollment in our study, 70% of the 30 cases in the high risk group required amputation, 40% of the 5 cases in medium risk groups underwent amputation whereas amputation was redundant in all 15 cases belonging to the low risk group. According to our study, the DIAFORA score has a sensitivity of 91.3% and specificity of 66.7%. CONCLUSION- With a prevalence of approximately 15% diabetic foot in India, this study is a paradigm to predict the amputation in high risk patients. Along with stringent blood sugar control we recommend utilization of DIAFORA score in regular clinical practice by clinicians to predict and prevent amputation in Diabetics and hence improve their quality of life.