Mugambi-Nturibi E, Otieno C F, Kwasa T O O, Oyoo G O, Acharya K
Kenyatta National Hospital, P.O. Box 29774-00202, Nairobi, Kenya.
East Afr Med J. 2009 May;86(5):233-9. doi: 10.4314/eamj.v86i5.54195.
Patients with diabetes mellitus are at a higher risk of lower extremity complications as compared to their non-diabetic counterparts.
To study risk factors for diabetic foot ulcer disease and stratify patients with diabetes into risk categories for foot ulceration.
Cross-sectional descriptive study over five months period.
Diabetic outpatient clinic, at the Kenyatta National Hospital.
Two hundred and eighteen ambulatory subjects with diabetes mellitus without active foot lesions.
The prevalence of previous foot ulceration was 16% while that of previous amputation was 8%. Neuropathy was present in 42% of the study subjects and was significantly associated with age, male gender, duration of diabetes, random blood sugar, systolic blood pressure and the presence of foot deformity. Peripheral arterial disease was present in 12% and showed significant association with male gender. Foot deformities were observed in 46% of study subjects and were significantly associated with age, male gender, and presence of neuropathy. Subsequently 57% were categorised into IWGDF group 0--no neuropathy, 10% were placed in group 1--neuropathy alone, 16% were put in group 2--neuropathy plus either peripheral arterial disease or foot deformity and 17% were placed in risk group 3--previous foot ulceration/amputation.
More than one third (33%) of diabetic patients were found to be at high risk for future foot ulceration (IWGDF groups 2 and 3). Published evidence exists that shows improved outcomes with interventions targeting individual patients with diabetes at high-risk of foot ulceration. Long term prospective studies to determine outcomes for the different risk categories should be carried out locally.
与非糖尿病患者相比，糖尿病患者发生下肢并发症的风险更高。
研究糖尿病足溃疡疾病的危险因素，并将糖尿病患者分为足部溃疡风险类别。
为期五个月的横断面描述性研究。
肯尼亚国家医院糖尿病门诊。
218名无足部活动性病变的糖尿病门诊患者。
既往足部溃疡的患病率为16%，既往截肢的患病率为8%。42%的研究对象存在神经病变，且与年龄、男性性别、糖尿病病程、随机血糖、收缩压和足部畸形显著相关。外周动脉疾病的患病率为12%，且与男性性别显著相关。46%的研究对象观察到足部畸形，且与年龄、男性性别和神经病变显著相关。随后，57%被归类为国际糖尿病足工作组（IWGDF）0组——无神经病变，10%被归为1组——仅神经病变，16%被归为2组——神经病变加外周动脉疾病或足部畸形，17%被归为风险3组——既往足部溃疡/截肢。
发现超过三分之一（33%）的糖尿病患者未来发生足部溃疡的风险较高（IWGDF 2组和3组）。已有公开证据表明，针对足部溃疡高风险的糖尿病个体患者进行干预可改善预后。应在当地开展长期前瞻性研究以确定不同风险类别的预后情况。
