Predicting the risk of future diabetic foot ulcer occurrence: a prospective cohort study of patients with diabetes in Tanzania

Abstract

ObjectivesThe aim of this study was to identify the parameters that predict the risk of future foot ulcer occurrence in patients with diabetes.Research design and methods1810 (male (M)/female (F): 1012/798) patients, with no foot ulcer at baseline, participated in this study. Data from a set of 28 parameters were collected at baseline. During follow-up, 123 (M/F: 68/55) patients ulcerated. Survival analyses together with logistic regression were used to identify the parameters that could predict the risk of future diabetic foot ulcer occurrence.ResultsA number of parameters (HR (95% CI)) including neuropathy (2.525 (1.680 to 3.795)); history of ulceration (2.796 (1.029 to 7.598)); smoking history (1.686 (1.097 to 2.592)); presence of callus (1.474 (0.999 to 2.174)); nail ingrowth (5.653 (2.078 to 15.379)); foot swelling (3.345 (1.799 to 6.218)); dry skin (1.926 (1.273 to 2.914)); limited ankle (1.662 (1.365 to 2.022)) and metatarsophalangeal (MTP) joint (2.745 (1.853 to 4.067)) ranges of motion; and decreased (3.141 (2.102 to 4.693)), highly decreased (5.263 (1.266 to 21.878)), and absent (9.671 (5.179 to 18.059)) sensation to touch; age (1.026 (1.010 to 1.042)); vibration perception threshold (1.079 (1.060 to 1.099)); duration of diabetes (1.000 (1.000 to 1.000)); and plantar pressure at the first metatarsal head (1.003 (1.001 to 1.005)), temperature sensation (1.019 (1.004 to 1.035)) and temperature tolerance (1.523 (1.337 to 1.734)) thresholds to hot stimuli and blood sugar level (1.027 (1.006 to 1.048)) were all significantly associated with increased risk of ulceration. However, plantar pressure underneath the fifth toe (0.990 (0.983 to 0.998)) and temperature sensation (0.755 (0.688 to 0.829)) and temperature tolerance (0.668 (0.592 to 0.0754)) thresholds to cold stimuli showed to significantly decrease the risk of future ulcer occurrence. Multivariate survival model indicated that nail ingrowth (4.42 (1.38 to 14.07)); vibration perception threshold (1.07 (1.04 to 1.09)); dry skin status (4.48 (1.80 to 11.14)); and temperature tolerance threshold to warm stimuli (1.001 (1.000 to 1.002)) were significant predictors of foot ulceration risk in the final model. The mean time to ulceration was significantly (p<0.05) shorter for patients with: dry skin (χ2=11.015), nail ingrowth (χ2=14.688), neuropathy (χ2=21.284), or foot swelling (χ2=16.428).ConclusionNail ingrowth and dry skin were found to be strong indicators of vulnerability of patients to diabetic foot ulceration. Results highlight that assessments of neuropathy in relation to both small and larger fiber impairment need to be considered for predicting the risk of diabetic foot ulceration.

Predicting the risk of amputation and death in patients with diabetic foot ulcer. A long‐term prospective cohort study of patients in Tanzania

“…A number of parameters (HR [95%CI]) were found to be associated with the risk of amputation. Neuropathy (6.415 [1.119–36.778]), as in our previous study, 25 we found neuropathy as one of the main risk factor for ulceration, which is also associated with risk of amputation as was indicated in the systematic review of patients with end‐stage renal failure. 26 …”

“…A number of parameters (HR [95%CI]) were found to be associated with the risk of amputation. Neuropathy (6.415 [1.119-36.778]), as in our previous study, 25 we found neuropathy as one of the main risk factor for ulceration, which is also associated with risk of amputation as was indicated in the systematic review of patients with end-stage renal failure. 26 PAD (9.741 [1.932-49.109]); that is in line with the previous study in which the participants with a history of PAD, were found to have 23.06 times the risk of amputation compared with those with no history of PAD when they followed for a median of 36 months.…”

<p>Incidence of Diabetic Foot Ulcer and Its Predictors Among Diabetes Mellitus Patients at Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia: A Retrospective Follow-Up Study</p>

“…Of clinically related factors, duration of DM, 28,37 increased body mass index (BMI), 31,37 increased hemoglobin A1c (HgbA1c), 33,38 higher low-density lipoprotein (LDL), higher triglyceride level, and lower high-density lipoprotein (HDL) level [39][40][41][42] are associated with increased risk for vascular complication including DFU. Comorbidities like retinopathy, 23,43 nephropathy, 23,37,41,44 and neuropathy 31,[45][46][47][48] are also associated with an increased risk of having DFU.…”

Prediction of callus and ulcer development in patients with diabetic peripheral neuropathy by isosceles triangle-forming tuning fork

“…Cognizance is raised to the clinical fact that vibration perception and touch-pressure sensation tests are important in assessing the risk of developing diabetic foot lesions, 48 and it has been reported that the combination of vibration testing using a tuning fork and touch-pressure testing using an SWM provides results that are comparable to those of the International Consensus on the Diabetic Foot. 49 In these reports, the conventional vibration testing method was used.…”