M V Hospital for Diabetes and Professor M Viswanathan Diabetes Research Centre, Chennai, Tamil Nadu, India
Centre for Diabetes Care, Greater Noida, Uttar Pradesh, India.
BMJ Open Diabetes Res Care. 2024 Aug 3;12(4):e004064. doi: 10.1136/bmjdrc-2024-004064.
Evidence on the prevalence of foot problems among people with diabetes in India at a national level is lacking. Hence, this study was aimed to assess the burden of high-risk (HR) feet in people with diabetes across India.
A cross-sectional national-level project 'Save the Feet and Keep Walking' campaign was conducted by the Research Society for the Study of Diabetes in India (RSSDI) from July 10, 2022 to August 10, 2022. A modified version of 3 min foot examination was used to assess the foot problems. Around 10 000 doctors with RSSDI membership were trained online to conduct foot screening and provided a standardised monofilament for detection of loss of protective sensation. People with diabetes aged >18 years who visited the clinics during the study period were examined for foot problems. Data were collected online using the semi-structured questionnaire. A total of 33 259 participants with complete information were included for the final analysis. The foot at risk was categorised based on International Working Group on the Diabetic Foot guidelines 2023.
Nearly 75% of the participants were aged above 45 years. Around 49% had diabetes duration >5 years and uncontrolled diabetes (hemoglobin A1c >8%). Presence of history of foot ulcer (20%), lower limb amputation (15.3%), foot deformities (24.5%) and absence of diminished dorsal pedis and posterior tibial pulses (26.4%) was noted in the study participants. Around 25.2% of them had HR feet and highly prevalent among males. Diabetic kidney and retinal complications were present in 70% and 75.5% of people with HR feet. Presence of heel fissures (OR (95% CI) 4.6 (4.2 to 5.1)) and callus or corns (OR (95% CI) 3.6 (3.3 to 4.0)) were significantly associated with HR feet.
One-fourth of people with diabetes were found to have HR feet in India. The findings are suggestive of regular screening of people with diabetes for foot problems and strengthening of primary healthcare.
目前，印度全国范围内缺乏有关糖尿病患者足部问题患病率的证据。因此，本研究旨在评估印度各地糖尿病患者高风险（HR）足部的负担。
2022 年 7 月 10 日至 2022 年 8 月 10 日，印度研究糖尿病学会（RSSDI）开展了一项名为“拯救足部，继续行走”的全国性横断面项目。使用改良的 3 分钟足部检查来评估足部问题。大约 10000 名 RSSDI 会员医生接受了在线足部筛查培训，并提供了标准的单丝用于检测保护性感觉丧失。在研究期间访问诊所的年龄>18 岁的糖尿病患者接受了足部问题检查。使用半结构化问卷在线收集数据。共纳入 33259 名具有完整信息的参与者进行最终分析。根据 2023 年国际糖尿病足工作组指南对有风险的足部进行分类。
近 75%的参与者年龄在 45 岁以上。约 49%的患者糖尿病病程>5 年且血糖控制不佳（糖化血红蛋白 A1c>8%）。研究参与者中存在足部溃疡史（20%）、下肢截肢（15.3%）、足部畸形（24.5%）和足背动脉和胫后动脉搏动减弱或消失（26.4%）。约 25.2%的人存在 HR 足部，男性中更为常见。70%和 75.5%的 HR 足部患者存在糖尿病肾病和视网膜并发症。存在足跟皲裂（比值比 [OR]（95%置信区间）4.6（4.2 至 5.1））和胼胝或鸡眼（OR（95%置信区间）3.6（3.3 至 4.0））与 HR 足部显著相关。
印度发现四分之一的糖尿病患者存在 HR 足部。这些发现提示应对糖尿病患者进行定期的足部问题筛查，并加强基层医疗保健。
