Improving foot ulcer risk assessment and identifying associated factors: Results of an initiative enhancing diabetes care in primary settings
Background: Diabetes-related lower extremity complications contribute significantly to the overall disability burden of type 2 diabetes (T2D). The screening of Diabetic Foot Ulcer (DFU) risk is essential for the early identification of its components, thereby preventing the progression to advanced c...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | Diabetes Epidemiology and Management |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666970623000744 |
| _version_ | 1827377912199774208 |
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| author | Ruben Silva-Tinoco Teresa Cuatecontzi-Xochitiotzi Yunuen Reyes-Paz Bianca Vidal-Santos Ana Galíndez-Fuentes Lilia Castillo-Martínez |
| author_facet | Ruben Silva-Tinoco Teresa Cuatecontzi-Xochitiotzi Yunuen Reyes-Paz Bianca Vidal-Santos Ana Galíndez-Fuentes Lilia Castillo-Martínez |
| author_sort | Ruben Silva-Tinoco |
| collection | DOAJ |
| description | Background: Diabetes-related lower extremity complications contribute significantly to the overall disability burden of type 2 diabetes (T2D). The screening of Diabetic Foot Ulcer (DFU) risk is essential for the early identification of its components, thereby preventing the progression to advanced complications. Unfortunately, identifying elements associated with foot ulcer development is often poorly executed, especially in primary care settings, particularly in low-middle-income countries. We assess the prevalence of DFU risk and its components while exploring sociodemographic, clinical, and behavioral characteristics linked to DFU risk in patients with T2D. Methods: This cross-sectional study examined the characteristics of the feet of subjects involved in an initiative to enhance the quality of diabetes care in primary healthcare settings. The assessment included the presence of foot deformities, peripheral neuropathy through Loss of Protective Sensation (LOPS) evaluation, peripheral arterial disease (PAD), and a history of foot ulcer or lower extremity amputations. Participants were classified according to the IWGDF Risk Classification and subsequently divided into two groups for analysis: those at high risk for DFU (Groups 1, 2, or 3) and those at low risk for DFU (Group 0). Logistic regression was employed to identify the factors associated with DFU risk and its components. Results: Among the 1361 patients evaluated, 63.8 % were found to be at an increased risk for DFU. The reported prevalence of foot deformities, LOPS, PAD, and a history of foot ulcer was 91.9 %, 44.3 %, 36.5 %, and 4.5 %, respectively. In the adjusted analysis, factors significantly associated with DFU risk included male gender (OR =2.01; 95 % IC 1.54–2.61), secondary education or less (OR =1.65, 95 % IC 1.27–2.14), diabetes duration exceeding 10 years (OR = 1.75, 95 % IC 1.34–2.30), chronic kidney disease (OR =1.44, 95 % IC 1.11 – 1.88), diabetic retinopathy (OR =1.93, 95 % IC 1.42–2.62), onychomycosis (OR =1.46, 95 % IC 1.14–1.88) properly cut toenails (OR =0.60, 95 % IC 0.45–0.79), and sedentary behavior (OR =1.56, 95 % IC 1.14–2.14). Conclusions: Risk assessment of DFU within a comprehensive care program for adults with T2D receiving conventional primary care showed that a substantial proportion of these patients are at an increased risk and, thus, qualify as candidates for interventions aimed at mitigating foot-related risks. We recommend that diabetes healthcare schemes incorporate preventive organizational interventions to facilitate the timely identification of DFU risk, particularly in primary care scenarios, thereby alleviating the burden of diabetes-related lower limb complications. |
| first_indexed | 2024-03-08T12:47:16Z |
| format | Article |
| id | doaj.art-50782494197b47ee9d5bb6256c82d9af |
| institution | Directory Open Access Journal |
| issn | 2666-9706 |
| language | English |
| last_indexed | 2024-03-08T12:47:16Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Diabetes Epidemiology and Management |
| spelling | doaj.art-50782494197b47ee9d5bb6256c82d9af2024-01-21T05:11:08ZengElsevierDiabetes Epidemiology and Management2666-97062024-04-0114100195Improving foot ulcer risk assessment and identifying associated factors: Results of an initiative enhancing diabetes care in primary settingsRuben Silva-Tinoco0Teresa Cuatecontzi-Xochitiotzi1Yunuen Reyes-Paz2Bianca Vidal-Santos3Ana Galíndez-Fuentes4Lilia Castillo-Martínez5Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico City, MexicoClinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico City, MexicoFacultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Mexico City, MexicoClinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico City, MexicoClinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico City, MexicoDepartment of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15 Col. Belisario Domínguez Sección XVI, Tlalpan CP 14080, Mexico City, Mexico; Corresponding author.Background: Diabetes-related lower extremity complications contribute significantly to the overall disability burden of type 2 diabetes (T2D). The screening of Diabetic Foot Ulcer (DFU) risk is essential for the early identification of its components, thereby preventing the progression to advanced complications. Unfortunately, identifying elements associated with foot ulcer development is often poorly executed, especially in primary care settings, particularly in low-middle-income countries. We assess the prevalence of DFU risk and its components while exploring sociodemographic, clinical, and behavioral characteristics linked to DFU risk in patients with T2D. Methods: This cross-sectional study examined the characteristics of the feet of subjects involved in an initiative to enhance the quality of diabetes care in primary healthcare settings. The assessment included the presence of foot deformities, peripheral neuropathy through Loss of Protective Sensation (LOPS) evaluation, peripheral arterial disease (PAD), and a history of foot ulcer or lower extremity amputations. Participants were classified according to the IWGDF Risk Classification and subsequently divided into two groups for analysis: those at high risk for DFU (Groups 1, 2, or 3) and those at low risk for DFU (Group 0). Logistic regression was employed to identify the factors associated with DFU risk and its components. Results: Among the 1361 patients evaluated, 63.8 % were found to be at an increased risk for DFU. The reported prevalence of foot deformities, LOPS, PAD, and a history of foot ulcer was 91.9 %, 44.3 %, 36.5 %, and 4.5 %, respectively. In the adjusted analysis, factors significantly associated with DFU risk included male gender (OR =2.01; 95 % IC 1.54–2.61), secondary education or less (OR =1.65, 95 % IC 1.27–2.14), diabetes duration exceeding 10 years (OR = 1.75, 95 % IC 1.34–2.30), chronic kidney disease (OR =1.44, 95 % IC 1.11 – 1.88), diabetic retinopathy (OR =1.93, 95 % IC 1.42–2.62), onychomycosis (OR =1.46, 95 % IC 1.14–1.88) properly cut toenails (OR =0.60, 95 % IC 0.45–0.79), and sedentary behavior (OR =1.56, 95 % IC 1.14–2.14). Conclusions: Risk assessment of DFU within a comprehensive care program for adults with T2D receiving conventional primary care showed that a substantial proportion of these patients are at an increased risk and, thus, qualify as candidates for interventions aimed at mitigating foot-related risks. We recommend that diabetes healthcare schemes incorporate preventive organizational interventions to facilitate the timely identification of DFU risk, particularly in primary care scenarios, thereby alleviating the burden of diabetes-related lower limb complications.http://www.sciencedirect.com/science/article/pii/S2666970623000744AmputationDiabetic complicationsDiabetic foot ulcer, diabetic neuropathyHealth care servicesPeripheral arterial disease |
| spellingShingle | Ruben Silva-Tinoco Teresa Cuatecontzi-Xochitiotzi Yunuen Reyes-Paz Bianca Vidal-Santos Ana Galíndez-Fuentes Lilia Castillo-Martínez Improving foot ulcer risk assessment and identifying associated factors: Results of an initiative enhancing diabetes care in primary settings Diabetes Epidemiology and Management Amputation Diabetic complications Diabetic foot ulcer, diabetic neuropathy Health care services Peripheral arterial disease |
| title | Improving foot ulcer risk assessment and identifying associated factors: Results of an initiative enhancing diabetes care in primary settings |
| title_full | Improving foot ulcer risk assessment and identifying associated factors: Results of an initiative enhancing diabetes care in primary settings |
| title_fullStr | Improving foot ulcer risk assessment and identifying associated factors: Results of an initiative enhancing diabetes care in primary settings |
| title_full_unstemmed | Improving foot ulcer risk assessment and identifying associated factors: Results of an initiative enhancing diabetes care in primary settings |
| title_short | Improving foot ulcer risk assessment and identifying associated factors: Results of an initiative enhancing diabetes care in primary settings |
| title_sort | improving foot ulcer risk assessment and identifying associated factors results of an initiative enhancing diabetes care in primary settings |
| topic | Amputation Diabetic complications Diabetic foot ulcer, diabetic neuropathy Health care services Peripheral arterial disease |
| url | http://www.sciencedirect.com/science/article/pii/S2666970623000744 |
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