Demography, blood glucose control, and predisposing causes of diabetic foot ulcers in hospitalized diabetic foot patients_West China Medical Journal

Authors：

ZHA Panpan ¹ , Bista Raju ¹ , RAN Yanhao ² , GONG Hongping ¹ , GAO Yun ¹ , CHEN Dawei ¹ , RAN Xingwu ¹ ,  WANG Chun ¹

1. Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WANG Chun, Email: snoopywc@163.com

Keywords：

Diabetic foot; Diabetic foot ulcers; Demographic characteristics; Blood glucose control; Predisposing cause

DOI：

10.7507/1002-0179.202103046

Video：

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Objective To investigate the epidemiological characteristics and predisposing causes of diabetic foot ulcer (DFU) in the hospitalized patients with diabetic foot disease (DFD).Methods The clinical data of patients with DFD admitted to West China Hospital of Sichuan University between January 1st, 2012 and December 31st, 2018 were collected through the electronic medical record system. The demographic characteristics, blood glucose control status, and the predisposing causes of DFU were analyzed.Results A total of 1 022 DFD inpatients with an average age of (65.5±11.9) years old were included in this study, including 679 males and 343 females; 59.4% (513/864) of the patients had a college degree or above, but the patients with more severe DFD had lower educational level (χ²_trend=19.554, P<0.001). The average time from diagnosis of diabetes mellitus to occurrence of DFD was (10.6±7.1) years, and 42.4% (433/1 022) of the patients had diabetes for over 10 years. Among the patients, 82.3% (841/1 022) treated diabetes irregularly, 56.2% (555/987) never monitored blood glucose, 51.2% (523/1 022) had a history of foot ulcers, and 8.6% (88/1 022) had a history of lower extremity or toe amputation. The average fasting blood glucose and hemoglobin A1c were (8.6±3.8) mmol/L and (8.2±2.1)%, respectively. There were 52.2% (525/1 006) and 94.4% (958/1 015) of the DFD patients companied with peripheral arterial disease and neuropathy, respectively. DFUs were mainly single (52.7%, 447/849) and neuro-ischemic ulcers (53.0%, 389/734). The main predisposing causes were physical causes (21.6%, 180/834) and trauma (19.2%, 160/834).Conclusions The patients with DFD have the characteristics of old age, long course of diabetes, irregular treatment of diabetes and poor control of blood glucose, combined with neurovascular diseases, and high recurrence rate of foot ulcer. Therefore, diabetes education, early screening of foot risk factors, and early intervention should be strengthened to prevent the occurrence and recurrence of DFU.

Citation： ZHA Panpan, Bista Raju, RAN Yanhao, GONG Hongping, GAO Yun, CHEN Dawei, RAN Xingwu, WANG Chun. Demography, blood glucose control, and predisposing causes of diabetic foot ulcers in hospitalized diabetic foot patients. West China Medical Journal, 2021, 36(4): 453-460. doi: 10.7507/1002-0179.202103046 Copy

1.	Monteiro-Soares M, Russell D, Boyko EJ, et al. Guidelines on the classification of diabetic foot ulcers (IWGDF 2019). Diabetes Metab Res Rev, 2020, 36(Suppl 1): e3273.
2.	Alayed MY, Younes N, Al-Smady M, et al. Prevalence of foot ulcers, foot at risk and associated risk factors among jordanian diabetics. Curr Diabetes Rev, 2017, 13(2): 182-191.
3.	Khanolkar MP, Bain SC, Stephens JW. The diabetic foot. QJM, 2008, 101(9): 685-695.
4.	Driver VR, Hanft J, Fylling CP, et al. A prospective, randomized, controlled trial of autologous platelet-rich plasma gel for the treatment of diabetic foot ulcers. Ostomy Wound Manage, 2006, 52(6): 68-70, 72, 74 passim.
5.	Armstrong DG, Swerdlow MA, Armstrong AA, et al. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res, 2020, 13(1): 16.
6.	王爱红, 赵湜, 李强, 等. 中国部分省市糖尿病足调查及医学经济学分析. 中华内分泌代谢杂志, 2005, 21(6): 496-499.
7.	班绎娟, 冉兴无, 杨川, 等. 中国部分省市糖尿病足病临床资料和住院费用等比较. 中华糖尿病杂志, 2014, 6(7): 499-503.
8.	Jiang Y, Wang X, Xia L, et al. A cohort study of diabetic patients and diabetic foot ulceration patients in China. Wound Repair Regen, 2015, 23(2): 222-230.
9.	中华医学会糖尿病学分会, 中华医学会感染病学分会, 中华医学会组织修复与再生分会. 中国糖尿病足防治指南(2019版)(Ⅱ). 中华糖尿病杂志, 2019, 11(3): 161-189.
10.	中华医学会糖尿病学分会, 中华医学会感染病学分会, 中华医学会组织修复与再生分会. 中国糖尿病足防治指南(2019版)(Ⅰ). 中华糖尿病杂志, 2019, 11(2): 92-108.
11.	Assaad-Khalil SH, Zaki A, Abdel Rehim A, et al. Prevalence of diabetic foot disorders and related risk factors among Egyptian subjects with diabetes. Prim Care Diabetes, 2015, 9(4): 297-303.
12.	Nyamu PN, Otieno CF, Amayo EO, et al. Risk factors and prevalence of diabetic foot ulcers at Kenyatta National Hospital, Nairobi. East Afr Med J, 2003, 80(1): 36-43.
13.	Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med, 1998, 15(7): 539-553.
14.	Perrin BM, Allen P, Gardner MJ, et al. The foot-health of people with diabetes in regional and rural Australia: baseline results from an observational cohort study. J Foot Ankle Res, 2019, 12: 56.
15.	Zhang P, Lu J, Jing Y, et al. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med, 2017, 49(2): 106-116.
16.	Rigato M, Pizzol D, Tiago A, et al. Characteristics, prevalence, and outcomes of diabetic foot ulcers in Africa. A systemic review and meta-analysis. Diabetes Res Clin Pract, 2018, 142: 63-73.
17.	Kateel R, Augustine AJ, Prabhu S, et al. Clinical and microbiological profile of diabetic foot ulcer patients in a tertiary care hospital. Diabetes Metab Syndr, 2018, 12(1): 27-30.
18.	Jiang Y, Ran X, Jia L, et al. Epidemiology of type 2 diabetic foot problems and predictive factors for amputation in China. Int J Low Extrem Wounds, 2015, 14(1): 19-27.
19.	Yazdanpanah L, Shahbazian H, Nazari I, et al. Risk factors associated with diabetic foot ulcer-free survival in patients with diabetes. Diabetes Metab Syndr, 2018, 12(6): 1039-1043.
20.	Paisey RB, Abbott A, Paisey CF, et al. Diabetic foot ulcer incidence and survival with improved diabetic foot services: an 18-year study. Diabet Med, 2019, 36(11): 1424-1430.
21.	American Diabetes Association. 11. Microvascular complications and foot care: standards of medical care in diabetes-2020. Diabetes Care, 2020, 43(Suppl 1): S135-S151.
22.	Peter-Riesch B. The diabetic foot: the never-ending challenge. Endocr Dev, 2016, 31: 108-134.

1. Monteiro-Soares M, Russell D, Boyko EJ, et al. Guidelines on the classification of diabetic foot ulcers (IWGDF 2019). Diabetes Metab Res Rev, 2020, 36(Suppl 1): e3273.
2. Alayed MY, Younes N, Al-Smady M, et al. Prevalence of foot ulcers, foot at risk and associated risk factors among jordanian diabetics. Curr Diabetes Rev, 2017, 13(2): 182-191.
3. Khanolkar MP, Bain SC, Stephens JW. The diabetic foot. QJM, 2008, 101(9): 685-695.
4. Driver VR, Hanft J, Fylling CP, et al. A prospective, randomized, controlled trial of autologous platelet-rich plasma gel for the treatment of diabetic foot ulcers. Ostomy Wound Manage, 2006, 52(6): 68-70, 72, 74 passim.
5. Armstrong DG, Swerdlow MA, Armstrong AA, et al. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res, 2020, 13(1): 16.
6. 王爱红, 赵湜, 李强, 等. 中国部分省市糖尿病足调查及医学经济学分析. 中华内分泌代谢杂志, 2005, 21(6): 496-499.
7. 班绎娟, 冉兴无, 杨川, 等. 中国部分省市糖尿病足病临床资料和住院费用等比较. 中华糖尿病杂志, 2014, 6(7): 499-503.
8. Jiang Y, Wang X, Xia L, et al. A cohort study of diabetic patients and diabetic foot ulceration patients in China. Wound Repair Regen, 2015, 23(2): 222-230.
9. 中华医学会糖尿病学分会, 中华医学会感染病学分会, 中华医学会组织修复与再生分会. 中国糖尿病足防治指南(2019版)(Ⅱ). 中华糖尿病杂志, 2019, 11(3): 161-189.
10. 中华医学会糖尿病学分会, 中华医学会感染病学分会, 中华医学会组织修复与再生分会. 中国糖尿病足防治指南(2019版)(Ⅰ). 中华糖尿病杂志, 2019, 11(2): 92-108.
11. Assaad-Khalil SH, Zaki A, Abdel Rehim A, et al. Prevalence of diabetic foot disorders and related risk factors among Egyptian subjects with diabetes. Prim Care Diabetes, 2015, 9(4): 297-303.
12. Nyamu PN, Otieno CF, Amayo EO, et al. Risk factors and prevalence of diabetic foot ulcers at Kenyatta National Hospital, Nairobi. East Afr Med J, 2003, 80(1): 36-43.
13. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med, 1998, 15(7): 539-553.
14. Perrin BM, Allen P, Gardner MJ, et al. The foot-health of people with diabetes in regional and rural Australia: baseline results from an observational cohort study. J Foot Ankle Res, 2019, 12: 56.
15. Zhang P, Lu J, Jing Y, et al. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med, 2017, 49(2): 106-116.
16. Rigato M, Pizzol D, Tiago A, et al. Characteristics, prevalence, and outcomes of diabetic foot ulcers in Africa. A systemic review and meta-analysis. Diabetes Res Clin Pract, 2018, 142: 63-73.
17. Kateel R, Augustine AJ, Prabhu S, et al. Clinical and microbiological profile of diabetic foot ulcer patients in a tertiary care hospital. Diabetes Metab Syndr, 2018, 12(1): 27-30.
18. Jiang Y, Ran X, Jia L, et al. Epidemiology of type 2 diabetic foot problems and predictive factors for amputation in China. Int J Low Extrem Wounds, 2015, 14(1): 19-27.
19. Yazdanpanah L, Shahbazian H, Nazari I, et al. Risk factors associated with diabetic foot ulcer-free survival in patients with diabetes. Diabetes Metab Syndr, 2018, 12(6): 1039-1043.
20. Paisey RB, Abbott A, Paisey CF, et al. Diabetic foot ulcer incidence and survival with improved diabetic foot services: an 18-year study. Diabet Med, 2019, 36(11): 1424-1430.
21. American Diabetes Association. 11. Microvascular complications and foot care: standards of medical care in diabetes-2020. Diabetes Care, 2020, 43(Suppl 1): S135-S151.
22. Peter-Riesch B. The diabetic foot: the never-ending challenge. Endocr Dev, 2016, 31: 108-134.

West China Medical Journal

Demography, blood glucose control, and predisposing causes of diabetic foot ulcers in hospitalized diabetic foot patients

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