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RISK FACTORS AND PREVALENCE OF DIABETIC FOOT ULCERS AT KENYATTA NATIONAL HOSPITAL, NAIROBI
Abstract
ABSTRACT
Background: Diabetic foot ulcers contribute significantly to the morbidity and mortality
of patients with diabetes mellitus. The diabetic patients with foot ulcers require long
hospitalisation and carry risk of limb amputation. The risk factors for developing
diabetic foot ulcers are manageable. In Kenya there is paucity of data on such risk
factors.
Objective: To determine the prevalence of diabetic foot ulcers and the risk factors in
a clinic-based setting .
Design: Cross-sectional study.
Setting: Kenyatta National Hospital, Kenya.
Subjects: Patients with both type 1 and 2 diabetes mellitus who had active foot ulcers
in both outpatient and inpatient units.
Main outcome measures: Diabetic foot ulcers glycated haemoglobin, neuropathy, peripheral
vascular disease and fasting lipid profile.
Results: One thousand seven hundred and eighty eight patients with diabetes mellitus
were screened and 82(4.6%) were found to have foot ulcers. The males and females
with diabetic foot ulcers were compared in age, duration of foot ulcers, blood pressure,
glycaemic control, neurological disability score and their proportion. Diabetic foot ulcers
occurred mostly in patients who had had diabetes for a long duration. The types of
(occurence) ulcers were neuropathic (47.5%), neuroischaemic (30.5%) and ischaemic
(18%). The neuropathic ulcers had significantly poorer glycaemic control compared to
other types and the longest duration (23.3 weeks). Ischaemic ulcers had significantly
higher total cholesterol and diastolic blood pressure compared to other ulcer types.
Wagner stage 2 ulcers were the commonest (49.4%) but stage 4 ulcers had their highest
neuropathic score (7.8/10) and longest duration (23.6weeks). Aerobic infective pathogens
were isolated from 73.2% of the ulcers.
Conclusion: The prevalence of diabetic foot ulcers was 4.6% in this tertiary clinic. The
risk factors of diabetic foot ulcers in the study were poor glycaemic control, diastolic
hypertension, dyslipidaemia, infection and poor self-care. These findings are similar to
studies done in other environments and they are modifiable to achieve prevention, delay
in formation or improved healing of foot ulcers in patients with diabetes. Therefore,
specific attention should be paid to the management of these risk factors in patients
with or without diabetes foot ulcers in this clinic.
Background: Diabetic foot ulcers contribute significantly to the morbidity and mortality
of patients with diabetes mellitus. The diabetic patients with foot ulcers require long
hospitalisation and carry risk of limb amputation. The risk factors for developing
diabetic foot ulcers are manageable. In Kenya there is paucity of data on such risk
factors.
Objective: To determine the prevalence of diabetic foot ulcers and the risk factors in
a clinic-based setting .
Design: Cross-sectional study.
Setting: Kenyatta National Hospital, Kenya.
Subjects: Patients with both type 1 and 2 diabetes mellitus who had active foot ulcers
in both outpatient and inpatient units.
Main outcome measures: Diabetic foot ulcers glycated haemoglobin, neuropathy, peripheral
vascular disease and fasting lipid profile.
Results: One thousand seven hundred and eighty eight patients with diabetes mellitus
were screened and 82(4.6%) were found to have foot ulcers. The males and females
with diabetic foot ulcers were compared in age, duration of foot ulcers, blood pressure,
glycaemic control, neurological disability score and their proportion. Diabetic foot ulcers
occurred mostly in patients who had had diabetes for a long duration. The types of
(occurence) ulcers were neuropathic (47.5%), neuroischaemic (30.5%) and ischaemic
(18%). The neuropathic ulcers had significantly poorer glycaemic control compared to
other types and the longest duration (23.3 weeks). Ischaemic ulcers had significantly
higher total cholesterol and diastolic blood pressure compared to other ulcer types.
Wagner stage 2 ulcers were the commonest (49.4%) but stage 4 ulcers had their highest
neuropathic score (7.8/10) and longest duration (23.6weeks). Aerobic infective pathogens
were isolated from 73.2% of the ulcers.
Conclusion: The prevalence of diabetic foot ulcers was 4.6% in this tertiary clinic. The
risk factors of diabetic foot ulcers in the study were poor glycaemic control, diastolic
hypertension, dyslipidaemia, infection and poor self-care. These findings are similar to
studies done in other environments and they are modifiable to achieve prevention, delay
in formation or improved healing of foot ulcers in patients with diabetes. Therefore,
specific attention should be paid to the management of these risk factors in patients
with or without diabetes foot ulcers in this clinic.
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