Factors Associated With Increased Prevalence of Diabetic Foot Ulcer and its Poor Outcome

Abstract

in our set up 
Study Design: Observational / prospective study 
Place and Duration of Study: This study was conducted at Bahawalpur Victoria Hospital, Bahawalpur from 
December 2015 to February 2016.  
Materials and Methods: One hundred and one patients above the age of 18 years presenting with DFU were 
enrolled. Detailed history was taken regarding patient’s education, type and duration of diabetes, smoking and  
comorbids like hypertension and ischemic heart disease(IHD). We evaluated ulcer for duration, site, pain and depth 
of wound.  
Results: Majority of patients were male(69.3%), had type 2 Diabetes(95%) and were uneducated(82.17%). Mean 
age was 59±10.43 years and mean duration of diabetes was 10.38±7.9 years. 32.6% patients had Hypertension, 
23.7% had IHD and 24.7% were smokers. 85.1% had sensory neuropathy and 41.58% had retinopathy. PAD(18.8%) 
and nephropathy(7.9%) were relatively uncommon.  Patients were divided into three groups based on outcome: 
healed(2.97%), unhealed(63.36%) and amputation(33.66%) group.  Mean duration of presentation was 24±10.39 
days in healed, 72.61±179.49 days in unhealed and 49.82±41.75 in amputation group. Wagner classification showed 
that 0% in healed, 70.31% in unhealed and 94.11% ulcers in amputation group were of grade 3 or above. Sensory  
neuropathy (94.11%)  and smoking(29.41%) were  more common and mean HbA1c(8.05±1.55) was highest in 
amputees. 
Conclusion: DFU is common in old, uneducated males with long duration of Diabetes. Hypertension, IHD, 
neuropathy, retinopathy and smoking were common in DFU patients. PAD and nephropathy were  uncommon.  We 
observed  high amputation and low healing rates. Sensory neuropathy, wagner grade (p values <0.05), poor 
glycemic control and smoking (p values >.05) were associated with poor outcome. Earlier presentation and 
aggressive treatment according  ulcer grade can improve outcome of this disabling morbidity.