Epidemiology Program, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
PLoS One. 2022 Oct 13;17(10):e0274754. doi: 10.1371/journal.pone.0274754. eCollection 2022.
Diabetes mellitus is one of the global public health problems and fasting blood sugar is an important indicator of diabetes management. Uncontrolled diabetes can lead to diabetic foot ulcers, which is a common and disabling complication. The association between fasting blood glucose level and the incidence of diabetic foot ulcers is rarely considered, and knowing its predictors is good for clinical decision-making. Therefore, the aim of this study was to determine the incidence and predictors of diabetic foot ulcers and its association with changes in fasting blood sugar among diabetes mellitus patients at referral hospitals in Northwest Ethiopia.
A multicenter retrospective follow-up study was conducted at a referral hospital in Northwest Ethiopia. A total of 539 newly diagnosed DM patients who had follow-up from 2010 to 2020 were selected using a computer-generated simple random sampling technique. Data was entered using Epi-Data 4.6 and analyzed in R software version 4.1. A Cox proportional hazard with a linear mixed effect model was jointly modeled and 95% Cl was used to select significant variables. AIC and BIC were used for model comparison.
A total of 539 diabetes patients were followed for a total of 28727.53 person-month observations. Overall, 65 (12.1%) patients developed diabetic foot ulcers with incidence rate of 2.26/1000-person month observation with a 95% CI of [1.77, 2.88]. Being rural (AHR = 2.30, 95%CI: [1.23, 4.29]), being a DM patient with Diabetic Neuropathy (AHR = 2.61, 95%CI: [1.12, 6.06]), and having peripheral arterial disease(PAD) (AHR = 2.96, 95%CI: [1.37, 6.40]) were significant predictors of DFU. The time-dependent lagged value of fasting blood sugar change was significantly associated to the incident of DFU (α = 1.85, AHR = 6.35, 95%CI [2.40, 16.79]).
In this study, the incidence of DFU was higher than in previous studies and was influenced by multiple factors like rural residence, having neuropathy, and PAD were significant predictors of the incidence of DFU. In addition, longitudinal changes in fasting blood sugar were associated with an increased risk of DFU. Health professionals and DM patients should give greater attention to the identified risk factors for DFU were recommended.
糖尿病是全球公共卫生问题之一，空腹血糖是糖尿病管理的重要指标。未得到控制的糖尿病会导致糖尿病足溃疡，这是一种常见且致残的并发症。空腹血糖水平与糖尿病足溃疡发病之间的关系很少被考虑，了解其预测因素有助于临床决策。因此，本研究旨在确定在埃塞俄比亚西北部转诊医院的糖尿病患者中糖尿病足溃疡的发生率和预测因素及其与空腹血糖变化的关系。
这是在埃塞俄比亚西北部的一家转诊医院进行的一项多中心回顾性随访研究。使用计算机生成的简单随机抽样技术，从 2010 年至 2020 年接受随访的 539 名新诊断的 DM 患者中选择了 539 名患者。数据使用 Epi-Data 4.6 输入，并在 R 软件版本 4.1 中进行分析。使用 Cox 比例风险与线性混合效应模型进行联合建模，并使用 95%Cl 选择显著变量。AIC 和 BIC 用于模型比较。
共有 539 名糖尿病患者接受了总计 28727.53 人月的随访。总体而言，有 65 名（12.1%）患者发生了糖尿病足溃疡，发病率为 2.26/1000 人月观察，95%CI [1.77, 2.88]。农村居民（AHR = 2.30，95%CI：[1.23, 4.29]）、患有糖尿病神经病变的糖尿病患者（AHR = 2.61，95%CI：[1.12, 6.06]）和外周动脉疾病（PAD）（AHR = 2.96，95%CI：[1.37, 6.40]）是 DFU 的显著预测因子。空腹血糖变化的时间依赖性滞后值与 DFU 的发生显著相关（α = 1.85，AHR = 6.35，95%CI [2.40, 16.79]）。
在这项研究中，DFU 的发病率高于先前的研究，并且受到多种因素的影响，如农村居民、神经病变和 PAD 是 DFU 发病率的显著预测因子。此外，空腹血糖的纵向变化与 DFU 的风险增加相关。建议卫生专业人员和糖尿病患者更加关注 DFU 的已识别危险因素。
