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Park, Ko, Lee, Cho, Moon, Jang, Son, Song, Cha, Son, and Ahn: Incidence of Diabetic Foot and Associated Risk Factors in Type 2 Diabetic Patients: A Five-year Observational Study
Original Article
Korean Diabetes Journal

Korean Diabetes Journal 2009; 33(4): 315-323.

Published online: 31 August 2009

DOI: https://doi.org/10.4093/kdj.2009.33.4.315

Incidence of Diabetic Foot and Associated Risk Factors in Type 2 Diabetic Patients: A Five-year Observational Study

Shin-Ae Park, Seung-Hyun Ko, Seung-Hwan Lee, Jae-Hyoung Cho, Sung-Dae Moon, Sang-A Jang, Hyun-Shik Son, Ki-Ho Song, Bong-Yun Cha, Ho-Young Son, Yu-Bae Ahn

Division of Endocrinology & Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.

Corresponding author (ybahn@catholic.ac.kr)

Received 19 February 2009       Accepted 1 July 2009

Copyright © 2009 Korean Diabetes Association

Abstract

Background

The frequency of lower extremity amputation due to diabetic foot has been increasing in type 2 diabetic patients. The aim of this study was to observe the incidence, clinical aspects and associated risk factors for diabetic foot.

Methods

We evaluated the incidence of diabetic foot through a five-year observation of type 2 diabetic patients who presented to St. vincent's Hospital between January and December 2003. To identify the risk factors for diabetic foot, we evaluated mean glycosylated hemoglobin A1c (HbA1c) every six months and assessed renal function based on the existence of proteinuria and estimated glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) equation. Patients were also evaluated for retinopathy, peripheral neuropathy and autonomic neuropathy using Ewing's method.

Results

From an initial pool of 613 patients, the observational study of 508 patients (82.9%) was completed. The mean age, duration of diabetes and HbA1c were 50.3 ± 10.6 yrs, 7.2 ± 6.5 yrs and 8.8 ± 2.1%, respectively. Diabetic foot occurred in 32 patients (6.3%). The incidence of diabetic foot increased when diabetic retinopathy (OR = 6.707, 2.314~19.439), peripheral neuropathy (OR = 2.949, 1.075~8.090), and autonomic neuropathy (OR = 3.967, 1.476~10.660) were present and when the MDRD GFR (OR = 5.089, 1.712~15.130) decreased. Mean HbA1c (OR = 12.013, 1.470~98.179) was found to be an independent risk factor for diabetic foot.

Conclusion

The present study confirmed the importance of intensive glycemic control and the role of autonomic dysfunction in the development of diabetic foot. In addition, diabetic retinopathy and impaired renal function proved to be factors associated with the occurrence of diabetic foot. Therefore, intensive glycemic control, as well as periodic examination of renal function, are essential for the prevention of diabetic foot.

Keywords: Diabetic foot, Diabetic neuropathies, Glycosylated hemoglobin A

Figures and Tables

Fig. 1
Study populations included in the analysis of diabetic foot.
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Table 1
Baseline characteristics of study subjects
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All data are expressed as means ± SD. CAN, Cardiovascular autonomic neuropathy; FPG, Fasting plasma glucose; HDL cholesterol, High density lipoprotein cholesterol; HOMAIR, Homeostasis Model Assessment-Insulin resistance; HOMAβcell, Homeostasis Model Assessment-beta cell; MDRD GFR, Modification of Diet in Renal Disease-Glomerular filtration rate; n, number (%); Nephropathy, 0-normal, 1-microalbuminuria, 2-macroalbuminuria; PPG, Postprandial plasma glucose; Retinopathy, 1-normal, 2-mild& moderate NPDR, 3-severe NPDR, 4-PDR.

Table 2
Comparison between diabetic foot (-) and diabetic foot (+) group
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All data are expressed as means ± SD. ARB, Angiotensin receptor blocker; CAN, Cardiovascular autonomic neuropathy; DF, Diabetic Foot; FPG, Fasting plasma glucose; HDL cholesterol, High density lipoprotein cholesterol; HOMAIR, Homeostasis Model Assessment-Insulin resistance; HOMAβcell, Homeostasis Model Assessment-beta cell; MDRD GFR, Modification of Diet in Renal Disease-Glomerular filtration rate; n, number (%); PPG, Postprandial plasma glucose.

Table 3
Clinical characteristics of diabetic foot group
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Amputation, antibiotics add amputation; Anemia, Hb < 10.0 g/dL; Antibiotics, only antibiotics; Debridement, antibiotics add debridement; Fever, Body temperature > 38.3℃; Hypoalbuminemia, albumin < 3.0 g/dL; Leukocytosis, WBC > 10.0 × 109/L; MRCNS, methicillin-resistant coagulase negative staphylococcus; MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-sensitive Staphylococcus aureus; n, number (%); Y, Yes.

Table 4
Risk factors of diabetic foot
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*Odd ratio for developing Diabetic Foot according to clinical characteristics by multiple logistic regression analysis. MDRD GFR, Modification of Diet in Renal Disease-Glomerular filtration rate.

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