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Park, Yang, Lee, and Kim: Factors Contributing to Diabetic Foot Ulcer among Patients with Type 2 Diabetes Mellitus
Original Research

Korean J Adult Nurs 2018;30(1):106-114.

Published online: 18 February 2018

DOI: https://doi.org/10.7475/KJAN.2018.30.1.106

Factors Contributing to Diabetic Foot Ulcer among Patients with Type 2 Diabetes Mellitus

Seo Jin Park1, Taeyoung Yang2, Jun Young Lee3, Jinhee Kim1,

1Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea

2Department of Medicine, Taeyoung 21 Hospital, Gwangju, Korea

3Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Korea

Corresponding author: Kim, Jinhee https://orcid.org/0000-0002-8037-9174 Department of Nursing, College of Medicine, Chosun University, 309 Pilmun-daero, Dong-Gu, Gwangju 61452, Korea. Tel: +82-62-230-6410, Fax: +82-62-230-6329, E-mail: jinheeara@chosun.ac.kr

- This research was supported by research fund from Chosun University in 2015.

- This manuscript is a revision of the first author's mater's thesis from Chosun University.

Received 15 November 201723 January 2018       Accepted 18 February 2018

© 2018 Korean Society of Adult Nursing

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify the factors contributing to diabetic foot ulcers (DFU) among patients with type 2 diabetes mellitus(DM).

Methods

Data were collected from 131 patients who had been diagnosed with DM for more than six months. Patients recruited from three hospitals in Gwangju city were given both a foot examination to confirm the presence of a foot ulcer and an individual time of survey using questionnaires about foot care knowledge and self management behavior.

Results

Factors contributing to DFU were male (adjusted odds ratio [aOR]=4.86, 95% confidence interval [CI]=1.16~20.44), history of DM-related hospitalization (aOR= 4.56, 95% CI=1.17~17.84), duration of DM (aOR=13.75, 95% CI=2.31~82.66 for those with time since diagnosis of 11~15 years; aOR=6.37, 95% CI=1.09~37.36 for those with time since diagnosis of 16-20 years; aOR=12.97, 95% CI=2.26~74.32 for those with time since diagnosis of over 21 years), DM diet (aOR=0.13, 95% CI=0.03-0.64 for those who did not practice dietary control), and exercise (aOR=15.59, 95% CI=3.49~69.64 for those who did not engage in regular exercise).

Conclusion

The factors identified in this study provided strategic information for developing educational program targeting patients with DM to prevent DFC.

Keywords: Type 2 diabetes mellitus, Diabetic foot, Exercise

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Table 1.
Diabetic Foot Ulcer according to Characteristics of Participants (N=131)
Variables Categories Total (n=131) With DFU (n=32) Without DFU (n=99) x2 or t p
n(%) n(%) n(%)
Gender Male 77(58.8) 27(84.4) 50(50.5) 11.45 ＜.001
Female 54(41.2) 5(15.6) 49(49.5)    
Age (year)   62.47±11.74 64.84±11.45 61.70±11.78 1.32 .188
≤59 53(40.5) (21.9)7 46(46.5) 8.28 .016
60~69 38(29.0) (46.9)15 23(23.2)    
≥70 40(30.5) 10(31.3) 30(30.3)    
Educational level (n=129) None 11(8.5) 5(15.6) 6(6.2) 3.74 .443
Elementary school 33(25.6) 9(28.1) 24(24.7)    
Junior high school 30(23.3) 5(15.6) 25(25.8)    
High school 29(22.5) 7(21.9) 22(22.7)    
≥ College 26(20.2) 6(18.8) 20(20.6)    
Marital status Married 98(74.8) 26(81.3) 72(72.7) 0.93 .334
Single 33(25.2) 6(18.8) 27(27.3)    
Smoking status Current smoker 21(16.0) 7(21.9) 14(14.1) 1.63 .442
Nonsmoker 73(55.7) 15(46.9) 58(58.6)    
Ex-smoker 37(28.2) 10(31.3) 27(27.3)    
History of hospitalization Yes 34(26.0) 20(62.5) 14(14.1) 29.43 ＜.001
No 97(74.0) 12(37.5) 85(85.9)    
Previous education for foot care (n=130) Yes 6(4.6) 3(9.4) 3(3.1) 2.18 .139
Never 124(95.4) 29(90.6) 95(96.9)    
BMI 　   23.96±3.38 23.65±2.50 24.06±3.62 0.71 .482
Underweight 3(2.3) (3.1)1 2(2.0) 3.11 .375
Normal 48(36.6) (34.4)11 37(37.4) 　 　
Overweight 35(26.7) (37.5)12 23(23.2)    
Obesity 45(34.4) 8(25.0) 37(37.4)    

DFU=diabetic foot ulcer; BMI=body mass index.

Table 2.
Diabetic Foot Ulcer according to Clinical Characteristics of Participants (N=131)
Variables Categories Total (n=131) With DFU (n=32) Without DFU (n=99) χ² or t p
n(%) n(%) n(%)
FPG (mg/dL) (n=113)   141.52±40.42 132.52±28.77 144.93±43.69 1.76 .083
＜110 7(6.2) 2(6.5) 5(6.1) 0.00 .945
≥110 106(93.8) 29(93.5) 77(93.9)    
Treatment with insulin Yes 26(19.8) 8(25.0) 18(18.2) 0.71 .401
No 105(80.2) 24(75.0) 81(81.8)    
Treatment with OHA Yes 125(95.4) 28(87.5) 97(98.0) 6.08 .014
No 6(4.6) 4(12.5) 2(2.0)    
Hypertension Yes 54(41.2) 16(50.0) 38(38.4) 1.35 .246
No 77(58.8) 16(50.0) 61(61.6)    
Retinopathy Yes 19(14.5) 0(0.0) 19(19.2) 7.18 .007
No 112(85.5) 32(100.0) 80(80.8)    
Nephropathy Yes 9(6.9) 1(3.1) 8(8.1) 0.93 .335
No 122(93.1) 31(96.9) 91(91.9)    
Foot deformity Yes 2(1.5) 1(3.1) 1(1.0) 0.72 .396
No 129(98.5) 31(96.9) 98(99.0)    
History of foot disease Yes 30(22.9) 10(31.3) 20(20.2) 1.67 .196
No 101(77.1) 22(68.8) 79(79.8)    
Duration of DM (year)   11.28±9.60 18.84±9.19 8.83±8.41 -5.72 ＜.001
≤10 78(59.5) (18.8)6 72(72.7) 31.65 ＜.001
11~15 15(11.5) (21.9)7 8(8.1)    
16~20 16(12.2) (18.8)6 10(10.1)    
≥21 22(16.8) 13(40.6) 9(9.1)    
DM diet Yes 29(22.1) 13(40.6) 16(16.2) 8.40 .004
No 102(77.9) 19(59.4) 83(83.8)    
Exercise 　 Yes 73(55.7) 9(28.1) 64(64.6) 13.07 ＜.001
No 58(44.3) 23(71.9) 35(35.4) 　 　

DFU=diabetic foot ulcer; DM=diabetes mellitus; FPG=fasting plasma glucose; OHA=oral hypoglycemic agents.

Table 3.
Foot-care Knowledge and Self-care Behavior (N=131)
Variables Total (n=131) With DFU (n=32) Without DFU (n=99) t p
M± SD M± SD M± SD
Knowledge 7.02±4.23 5.88±4.43 7.39±4.12 1.78 .077
Self-care behavior (n=124) 69.94±13.09 67.06±11.98 70.92±13.36 1.45 .151

DFU=diabetic foot ulcer.

Table 4.
Factors Contributing to Diabetic Foot Ulcer (N=131)
Variables Categories Unadjusted Adjusted∗
OR 95% CI p OR (95% CI) p
Gender Female 1 (Ref)     1 (Ref)    
Male 5.29 1.89~14.86 .002 4.86 1.16~20.44 .031
Age (year) ≤59 1 (Ref)     1 (Ref)    
60~69 4.29 1.53~11.97 .006 1.23 0.23~6.49 .812
≥70 2.19 0.75~6.39 .151 1.02 0.18~5.94 .980
History of hospitalization No 1 (Ref)     1 (Ref)    
Yes 10.12 4.07~25.19 ＜.001 4.56 1.17~17.84 .029
Treatment with OHA Yes 1 (Ref)     1 (Ref)    
No 6.93 1.21~39.80 .030 0.93 0.09~9.29 .951
Duration of DM (year) ≤10 1 (Ref)     1 (Ref)    
11~15 10.5 2.83~39.01 ＜.001 13.75 2.31~82.66 .004
16~20 7.2 1.94~26.70 .003 6.37 1.09~37.36 .040
≥21 17.33 5.27~56.97 ＜.001 12.97 2.26~74.32 .004
DM diet Yes 1 (Ref)     1 (Ref)    
No 0.28 0.12~0.68 .005 0.13 0.03~0.64 .012
Exercise Yes 1 (Ref)     1 (Ref)    
No 4.67 1.95~11.20 ＜.001 15.59 3.49~69.64 ＜.001

DFU=diabetic foot ulcer; OR=odds ratio; CI=confidence interval; Ref=reference; OHA=oral hypoglycemic agents; DM=diabetes mellitus.

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