Analysis Of Risk Factors Of Diabetic Foot

Diabetes mellitus (DM) is a globally epidemic non-infectious disease now, its chronic complications have a high chance to result in disability and death. Diabetic foot (DF) is one of the most serious chronic complications of DM, which is the principal cause of nontraumatic lower-extremity amputation, which effects the quality of life of patients with DM. The cost of treating DF is also greatly high. However DF is a kind of disease to prevention and treatment, It was manifested that the morbility of foot lesion can be lowed down by educating diabetic patients about relative risk factors to lead to DF, thus which can decrease the economic burden of family and society accordingly, elevate the quality of life of patients with DM.Objective:Analysis the risk factors of diabetic foot, in order to direct clinical doctors to screen the patient with high risk factors of DF, to discover DF early, to prevent and cure it early, which has the important significance of decreasing the morbility of DF and amputation.Materials and methods:1. Subjects: 35 (24 males and 11 females) in-ward patients with DF (DF group) hospitalized in Endocrine Department of Jilin University First Clinical Hospital from May, 2005 to October, 2006,average aged 60.4±10.5 years old, average duration of disease 8.82±6.82 years. 185 (84 males and 101females) in-ward diabetic patients (NDF group) hospitalized at the same time, average aged 60.4±10.5 years old and average duration of disease 8.82±6.82 years, who were randomly selected.the cases that complicated other disease of endocrine systerm and can't answer to question rightly bescause of conscious disturbance and mental subnormality were depleted.2. Clinical data: The data was observed including sex, years old, the duration of disease, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), the history of hypertension and smoking, complication of diabetic nephropathy (DN), diabetic retinopathy (DR), coronary artery disease (CHD) and cerbral infarction (CI), triglyeride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), fasting blood glucose (FBG), postprandial blood glucose (PBG), glycosylated hemoglobin (GHbA1c), ankle brachial index (ABI), vibration perception threshold (VPT).3. Criteria of diagnosis: The diagnosis of diabetes mellitus accorded with the new diagnostic criteria of WHO in 1999. The classification of DF was accordant with Wanger classification: 0 grade, having the risk factors of DF but no skin ulcer; 1 grade, having the skin ulcer but no infection; 2 grade, having deep ulcer, often complicating cellulitis but no abscess or infection of bone; 3 grade,having infection of deep tissue, often complicating the bone tissue lesion or abscess; 4 grade, the local gangrene of foot; 5 grade, the total gangrene of foot. It must be 1 grade or above foot that could be chosen.4. Method of statistics: Measurement data was showed by x±s, T-test was used to analyze measurement data; count data was showed by percentage, Chi-square was used to analyze count data. Multiple stepwise nonconditional regression analysis was used to assess the risks factors associated with DF. P value <0.05 was considered statistically significant.Results:1. Comparing the cases of the DF group with the NDF group, The patients'years was older and the duration of diabetes was longer in DF group (p<0.05), proportion (68.5% versus 42.5%) of male was also different (p<0.05); the rate of somking was no significant difference (p>0.05).2. Patients who complicated with CHD, DN and DR were more in DF group (P<0.05), the mobility of hypertension and CI were no significant difference between the DF group and the NDF group (p>0.05).3. The patients'SBP was higher in the DF group than theirs SBP in the NDF group (p<0.01), patients with ABI<0.9 and/or VPT>25 volt were more in the DF group than in the NDF group (p<0.01). thepatient's ABI value was lower in the DF group (p<0.01), the patient's DBP and BMI had no significant statistical difference (P>0.05).4. Comparing the cases of the DF group with the NDF group, FBG and GHbA1c were higher in the DF group (p<0.05), the level of blood lipid (including TG, TC, LDL-C, VLDL-C) and PBG had no significant statistical difference (p>0.05).5. Multiple stepwise nonconditional regression analysis showed that Male, ABI<0.9, VPT>25volt, GHbA1c and SBP were postively associated with occurrence of DF, were the independent risk factors of DF.6. There were 35 cases in the DF group, according to the Wagner classify method of DF, there were 6 (17.1%) cases that were 1 grade, 12 (34.3%) cases were 2 grade, 10 (28.6%) cases were 3 grade, 5 (14.3%) cases were 4 grade, 2 (5.7%) cases were 5 grade, the cases of 2 and 3 grade were common. according to the cause of diabetic foot disease, there were 11 (31.4%) cases that suffered from neurogenic ulcer in foot, 6 (17.1%) cases that suffered from vascular ulcer in foot, 18 (51.5%) cases that suffered from miscibilital ulcer (neurogenic and vascular ulcer) in foot, so the miscibilital ulcer was common.Conclusions:1. Age of diabetic patients with DF was older, duration of diabetic mellitus was longer, man was more and they alwayscomplicated with coronary artery disease and diabetic nephropathy and diabetic retinopathy, the control level of blood glucose and blood pressure was poor.2. The miscibilital ulcer was common in diabetic foot ulcer.3. Male, ABI<0.9, VPT>25volt, GHbA1c and SBP were the independent risk factors of DF.4. Patients of Diabetic mellitus should do medical examination regularly, especially measure ABI and VPT, in order to find the high risk patients with diabetic foot early, give them some corresponding management early, reduce the occurrence of diabetic foot.