Risk Factors And Related Analysis Of Foot Disease Severity In Type 2 Diabetic Foot

Objective: To retrospectively analyze the clinical characteristics of diabetic foot(DF)and the risk factors affecting the severity of diabetic foot in hospitalized patients with type 2 diabetes mellitus(T2DM)in the Affiliated Hospital of North Sichuan Medical College,To provide reference for the diagnosis and treatment of diabetic foot patients in this area,and to control risk factors to delay the progress of the disease,reduce the amputation rate of diabetic foot,reduce the burden of patients and improve the quality of life.Methods: 1.227 patients with type 2 diabetic foot hospitalized in the Affiliated Hospital of North Sichuan Medical College from December 2013 to January 2017 were collected.The number of type 2 diabetic foot patients hospitalized in the same period was 12584.Analysis of the proportion,regional distribution and characteristics of diabetic foot.2.In 227 patients with type 2 diabetic foot,179 patients who met the inclusion criteria were selected as subjects.According to Wagner classification,179 patients were divided into 6 groups,including 18 cases of grade 0,30 cases of grade 1,35 cases of grade 2,51 cases of grade 3,40 cases of grade 4 and 5 cases of grade 5.The differences of age,body mass index(BMI),course of diabetes,smoking history,occupation,hospitalization days and hospitalization expenses were compared among the groups.Meanwhile,the differences of fasting blood glucose(FBG),random blood glucose,glycosylated hemoglobin(HbA1c),triglyceride(TG),cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),serum creatinine(SCr),serum uric acid(UA)were compared among the groups.The incidence of diabetic peripheral neuropathy(DPN),diabetic nephropathy(DN),diabetic retinopathy(DR)and lower extremity arterial disease(LEAD)were compared.Result: 1.The diabetic foot patients hospitalized from December 2013 to January 2017 accounted for 1.8%(227/12584)of the type 2 diabetes patients hospitalized in the same period.227 cases of diabetic foot mainly come from the city,63.88% of them come from rural areas,36.12% from urban areas.2.The clinical characteristics of 179 subjects were as follows: manual workers accounted for 40.22%,retired workers accounted for 24.58%,mental workers accounted for 18.44%,other occupations accounted for 14.53%,and housewives accounted for 2.23%;ulcers occurred in 41.90% of 179 subjects in the sole and heel,toes accounted for 26.26%,15.08% in the dorsum of the feet,6.70% of them were located in ankle joint or above,and 10.06% of them were in Wagner grade 0 without ulcer.3.The clinical characteristics of 72 cases of diabetic foot with manual labor were 66.67% male and 33.33% female.Of them,61 cases had ulcers,27 cases occurred in sole and heel,accounting for 44.26%,19 cases in toe,31.15%,10 cases in dorsum of foot,accounting for 16.39%,5 cases in ankle joint and above,accounting for 8.20%.4.Comparison of diabetic foot patients with different Wagner grades: There were significant differences in diabetic course,fasting blood glucose(FBG),random blood glucose,glycosylated hemoglobin(HbA1c),high density lipoprotein cholesterol(HDL-C)and serum uric acid(UA)levels among the six groups(P < 0.05).Age,smoking history,body mass index(BMI),blood pressure and laboratory indicators such as triglyceride(TG),cholesterol(TC),Low density lipoprotein cholesterol(LDL-C)and serum creatinine(SCr)had no significant difference among different groups(P > 0.05).5.Comparisons of chronic complications of diabetes mellitus in six groups: the incidence of diabetic lower extremity arteriopathy(LEAD)was significantly different(P < 0.05);the incidence of diabetic nephropathy(DN),diabetic retinopathy(DR),diabetic peripheral neuropathy(DPN)was not significantly different among the groups(P > 0.05).6.There were significant differences in hospitalization expenses and days between the six groups(P < 0.05).7.Multivariate linear regression analysis showed that fasting blood glucose(FBG),glycosylated hemoglobin 9(HbA1c),blood uric acid(UA),diabetic lower extremity artery disease(LEAD)were independent risk factors affecting the severity of diabetic foot disease.Conclusion: The proportion of hospitalized patients with type 2 diabetic foot in our hospital was 1.8% in the same period.Most of the patients with type 2 diabetic foot in the Affiliated Hospital of North Sichuan Medical College came from rural areas with poor health and economic conditions in this city.Physical labor was the main occupation.The plantar and heel were the high-risk sites for ulceration in this group.With the aggravation of diabetic foot,the number of days in hospital and the cost of hospitalization increased.The course of diabetes,fasting blood glucose,glycosylated hemoglobin,random blood glucose,high density lipoprotein cholesterol,blood uric acid,diabetic lower extremity artery disease are related to the severity of diabetic foot disease.Fasting blood glucose,glycosylated hemoglobin,blood uric acid and diabetic lower extremity artery disease are independent risk factors affecting the severity of diabetic foot disease.