Incidence of Diabetic Foot Problems and Associated Risk Factors in Type 2 Diabetic Patients: A 5-Year Follow up Study
Abstract Number: 1107-P
Authors: SHIN-AE PARK, SEUNG-HYUN KO, SEUNG-HWAN LEE, SU-YOEN KIM, MEE-KYUNG KIM, HYUK-SANG KWON, KI-HO SONG, YU-BAE AHN
Institutions: Suwon, Republic of Korea
Results: The frequency of lower extremity amputation due to diabetic foot problems has been increasing in type 2 diabetic patients. This is reported to be reducible up to 50% through risk factor control and proper treatment of diabetic foot ulcer. The aim of this study was to observe the incidence of diabetic foot problems and to investigate the associated risk factors.
The incidence of diabetic foot problems was assessed in type 2 diabetic patients, who had visited an University Hospital from January to December 2003 during a 5-year follow-up study. To verify the risk factors, we collected data regarding each patient's age, sex, DM duration, BMI, examination for high blood pressure and smoking, HOMAIR, HOMAβcell, HbA1c. We also evaluated mean HbA1c every six months during the 5 years of follow-up, and assessed the renal function based on the existence of proteinuria and estimate GFR was derived from modification of diet in renal disease study equation. We examined for retinopathy, peripheral neuropathy and autonomic neuropathy using Ewing's methods.
Among 613 patients, the follow-up study of 508 patients (82.9%) was completed. The mean age, duration of diabetes and HbA1c were 50.3 ± 10.6, 7.2 ± 6.5yrs, 8.8 ± 2.1%. Diabetic foot problems occurred in 32 patients (6.3%). The diabetic foot problems increased when diabetic retinopathy (OR = 6.707, 95%CI 2.314-19.439), peripheral neuropathy (OR = 2.949, 95%CI 1.075-8.090), autonomic neuropathy (OR = 3.967, 95%CI 1.476-10.660) were accompanied, and MDRD GFR (OR = 5.089, 95%CI 1.712-15.130) decreased. Moreover, mean HbA1c (OR = 12.013, 95%CI 1.470-98.179) was also proved to be an independent risk factor during the follow-up.
Diabetic retinopathy and the decrease in renal function proved to be the main factors of the occurrence of diabetic foot problems. Also, the importance of intensive glycemic control and autonomic dysfunction was confirmed to be involved in foot problems. Therefore, in order to prevent diabetic foot problems, it is necessary to have regular assessment of renal function and autonomic function test at the same time, as well as intensive glycemic control.