Community Medicine, Bangladesh Institute of Health Sciences, Dhaka, Bangladesh
Noncommunicable Diseases, Bangladesh University of Health Sciences, Dhaka, Bangladesh.
BMJ Open. 2020 Feb 28;10(2):e034058. doi: 10.1136/bmjopen-2019-034058.
To assess the risk of diabetic foot ulcer (DFU) and find out its associated factors among subjects with type 2 diabetes (T2D) of Bangladesh.
DESIGN, SETTING AND PARTICIPANTS: This cross-sectional study recruited 1200 subjects with T2D who visited 16 centres of Health Care Development Project run by Diabetic Association of Bangladesh.
Risk of DFU was assessed using a modified version of International Working Group on the Diabetic Foot (IWGDF) Risk Classification System. The modified system was based on five parameters, namely peripheral neuropathy (PN), peripheral arterial diseases (PAD), deformity, ulcer history and amputation. The risks were categorised as group 0 (no PN, no PAD), group 1 (PN, no PAD and no deformity), group 2A (PN and deformity, no PAD), group 2B (PAD), group 3A (ulcer history) and group 3B (amputation). The associated factors of DFU risk were determined using multinomial logistic regression for each risk category separately.
Overall, 44.5% of the subjects were found 'at risk' of DFU. This risk was higher among men (45.6%) than women and among those who lived in rural areas (45.5%) as compared with the urban population. According to IWGDF categories, the risk was distributed as 55.5%, 4.2%, 11.6%, 0.3%, 20.6% and 7.9% for group 0, group 1, group 2A, group 2B, group 3A and group 3B, respectively. The associated factors of DFU (OR >1) were age ≥50 years, rural area, low economic status, insulin use, history of trauma, diabetic retinopathy and diabetic nephropathy.
A significant number of the subjects with T2D under study were at risk of DFU, which demands an effective screening programme to reduce DFU-related morbidity and mortality.
评估孟加拉国 2 型糖尿病（T2D）患者发生糖尿病足溃疡（DFU）的风险，并找出其相关因素。
设计、地点和参与者：本横断面研究招募了 1200 名来自孟加拉国糖尿病协会运营的卫生保健发展项目 16 个中心的 T2D 患者。
使用国际糖尿病足工作组（IWGDF）风险分类系统的改良版本评估 DFU 风险。改良系统基于 5 个参数，即周围神经病变（PN）、周围动脉疾病（PAD）、畸形、溃疡史和截肢。风险分为 0 组（无 PN，无 PAD）、1 组（PN，无 PAD 且无畸形）、2A 组（PN 和畸形，无 PAD）、2B 组（PAD）、3A 组（溃疡史）和 3B 组（截肢）。使用多项逻辑回归分别确定每个风险类别的 DFU 风险相关因素。
总体而言，44.5%的患者存在 DFU 风险。男性（45.6%）比女性和农村地区（45.5%）的风险更高，而城市人口的风险较低。根据 IWGDF 分类，风险分布为 0 组、1 组、2A 组、2B 组、3A 组和 3B 组的 55.5%、4.2%、11.6%、0.3%、20.6%和 7.9%。DFU 的相关因素（OR>1）包括年龄≥50 岁、农村地区、经济状况低、使用胰岛素、创伤史、糖尿病视网膜病变和糖尿病肾病。
研究中相当一部分 T2D 患者存在 DFU 风险，这需要有效的筛查计划来降低 DFU 相关发病率和死亡率。
