dr. neeta deshpande

1. PREVALENCE OF RISKPREVALENCE OF RISK
FACTORS FOR DIABETICFACTORS FOR DIABETIC
FOOT ULCER AND RISKFOOT ULCER AND RISK
STRATIFICATION IN TYPE 2STRATIFICATION IN TYPE 2
DIABETESDIABETES
DR. NEETA DESHPANDEDR. NEETA DESHPANDE
ASSOCIATE PROF.,JNASSOCIATE PROF.,JN
MEDICAL COLLEGE AND KLEMEDICAL COLLEGE AND KLE
HOSPITAL, BELGAUMHOSPITAL, BELGAUM

2. INTRODUCTIONINTRODUCTION
40-70% of LL amputations related to40-70% of LL amputations related to
DMDM
Substantial emotional, physical andSubstantial emotional, physical and
financial lossesfinancial losses
Illiteracy, lack of knowledgeIlliteracy, lack of knowledge
Largely preventable through earlyLargely preventable through early
detection of “high-risk” feet,detection of “high-risk” feet,
preventive footwear and counselingpreventive footwear and counseling

3. AIMS AND OBJECTIVESAIMS AND OBJECTIVES
To know prevalence of risk factorsTo know prevalence of risk factors
for diabetic foot ulceration andfor diabetic foot ulceration and
stratification into risk categoriesstratification into risk categories
To correlate risk categories to age,To correlate risk categories to age,
duration of DM, glycemic control andduration of DM, glycemic control and
SESSES

4. INCLUSION CRITERIAINCLUSION CRITERIA
All known cases of type 2 DM of moreAll known cases of type 2 DM of more
than 1 year durationthan 1 year duration

5. EXCLUSION CRITERIAEXCLUSION CRITERIA
Patients with current foot ulcerPatients with current foot ulcer
Patients of DM admitted for otherPatients of DM admitted for other
neurological causesneurological causes

6. METHODOLOGYMETHODOLOGY
215 type 2 diabetics who were215 type 2 diabetics who were
willing to participate in the studywilling to participate in the study
were questioned in detail – age,were questioned in detail – age,
duration of diabetes, footwearduration of diabetes, footwear
practices, level of education,practices, level of education,
symptoms of neuropathy,symptoms of neuropathy,
vasculopathy, previous footvasculopathy, previous foot
ulcer/amputationulcer/amputation
Thorough foot examination was doneThorough foot examination was done
Blood sample was collected forBlood sample was collected for
HbA1cHbA1c

7. Definitions of recorded dataDefinitions of recorded data
HISTORY OF FOOT ULCER – HealedHISTORY OF FOOT ULCER – Healed
foot ulcer of more than 3 monthsfoot ulcer of more than 3 months
durationduration
HISTORY OF LL AMP – Non-traumaticHISTORY OF LL AMP – Non-traumatic
amp at any level in the LLamp at any level in the LL
PAD – Intermittent claudication orPAD – Intermittent claudication or
h/o reconstructive vascular surgeryh/o reconstructive vascular surgery
and/or absence of foot pulsesand/or absence of foot pulses

8. Definitions of recorded data - contdDefinitions of recorded data - contd
SENSORY NEUROPATHY -SENSORY NEUROPATHY - >> 1 “no1 “no
response” to 10 g MF applied to 10response” to 10 g MF applied to 10
sites (9 plantar and 1 dorsal) and/orsites (9 plantar and 1 dorsal) and/or
NDSNDS
FOOT DEFORMITY – hallux valgus,FOOT DEFORMITY – hallux valgus,
overlapping toes, fixed clawed toes,overlapping toes, fixed clawed toes,
pes cavus/planus, Charcot foot,pes cavus/planus, Charcot foot,
prominent metatarsal headsprominent metatarsal heads

9. NEUROPATHY DISABILITYNEUROPATHY DISABILITY
SCORE – RIGHT AND LEFTSCORE – RIGHT AND LEFT
VibrationVibration sensesense
(dorsum of big toe)(dorsum of big toe)
: Present=0,: Present=0,
reduced/absent=1reduced/absent=1
Pin prickPin prick ::
Present=0,Present=0,
reduced/absent=1reduced/absent=1
Ankle jerkAnkle jerk ::
present=0, presentpresent=0, present
onon
reinforcement=1,reinforcement=1,
absent=2absent=2
TOTAL SCORE:TOTAL SCORE:
3-4 Mild neuropathy3-4 Mild neuropathy
5-7 Moderate5-7 Moderate
8-10 Severe8-10 Severe

10. CLASSIFICATION OF INTERNATIONALCLASSIFICATION OF INTERNATIONAL
WORKING GROUP ON DIABETIC FOOTWORKING GROUP ON DIABETIC FOOT
RISK CATEGORYRISK CATEGORY
00
11
22
33
DESCRIPTIONDESCRIPTION
No sensoryNo sensory
neuropathyneuropathy
Sensory neuropathySensory neuropathy
onlyonly
SN+PVD &/orSN+PVD &/or
deformitydeformity
PreviousPrevious
ulcer/amputationulcer/amputation

11. Statistical MethodsStatistical Methods
.Chi – square test and unpaired ‘t’ test.Chi – square test and unpaired ‘t’ test

12. Age and Sex distributionAge and Sex distribution
AGEAGE MALEMALE FEMALEFEMALE TOTALTOTAL
45-5545-55 7070 3838 108108
56-6556-65 4242 3737 7979
66-7566-75 1818 44 2222
76-8576-85 44 22 0606
134134 8181 215215

13. Duration of diabetesDuration of diabetes
61
77
58
12
7
0
10
20
30
40
50
60
70
80
No.ofCases
< 5 6 to 10 11 to 15 16 to 20 > 20
Duration of Diabetes

14. Prevalence of risk factorsPrevalence of risk factors
CASESCASES PERCENTAGEPERCENTAGE
NeuropathyNeuropathy 8383 38.638.6
VasculopathyVasculopathy 2222 10.2310.23
FootFoot
deformitydeformity
1212 5.585.58
PrevPrev
ulcer/ampulcer/amp
1010 4.654.65

15. Prevalence of risk factorsPrevalence of risk factors
83
22
12 10
0
10
20
30
40
50
60
70
80
90
No.ofCases
Neuropathy Vasculopathy Foot deformities Previous ulcer or
amputation
Graph showing Prevalence of Neuropathy, Vasculopathy, Foot deformities
and previous ulcer or amputation in the study population

16. Neuropathy Disability ScoreNeuropathy Disability Score
No. Of CasesNo. Of Cases PercentagePercentage
Mild (NDS 3-Mild (NDS 3-
4)4)
4545 54.2254.22
Mod (NDS 5-Mod (NDS 5-
7)7)
1616 19.2819.28
Severe (NDSSevere (NDS
8-10)8-10)
2222 26.5026.50

17. Mean duration of diabetesMean duration of diabetes
Mean (Years)Mean (Years) SDSD
Group 0Group 0 54.854.8 2.72.7
Group 1Group 1 1212 2.612.61
Group 2Group 2 17.517.5 1.451.45
Group 3Group 3 2121 3.623.62

18. Mean duration of diabetesMean duration of diabetes
5.8
12
17.5
21
0
5
10
15
20
25
Meandurationofdiabetes(Yrs)
Group 0 Group 1 Group 2 Group 3
Graph showing mean duration of diabetes in each group distribution

19. Mean AgeMean Age
52.9
59.28
68.92
76
0
10
20
30
40
50
60
70
80
MeanAgeofthePatients
(Yrs)
Group 0 Group 1 Group 2 Group 3
Graph showing mean age of the patients in each group distribution

20. Glycemic controlGlycemic control
HbA1cHbA1c GoodGood
(<8%)(<8%)
FairFair
(8.1-(8.1-
10%)10%)
PoorPoor
(>10%)(>10%)
Group 0Group 0 6464 2020 1616
Group 1Group 1 4343 4949 88
Group 2Group 2 2525 3333 4242
Group 3Group 3 1010 4040 5050

21. Glycemic controlGlycemic control
64
20
16
43
49
8
25
33
42
10
40
50
0
10
20
30
40
50
60
70
Percentage
Group 0 Group 1 Group 2 Group 3
Graph showing Percentage of patients of different glycemic control in
each group distribution
Good Fair Poor

22. Barefoot walkingBarefoot walking
42
58
70
30
83
17
100
0
0
20
40
60
80
100
Percentage
Group 0 Group 1 Group 2 Group 3
Graph showing Percentage of Bare foot walkers in each group
distribution
Present Absent

23. Level of educationLevel of education
44 45 43
49
32
19
75
17
8
100
0 0
0
20
40
60
80
100
Percentage
Group 0 Group 1 Group 2 Group 3
Graph showing level of Education in group
Iliterate Schooling College

24. ConclusionsConclusions
Overall prevalence of neuropathy is higherOverall prevalence of neuropathy is higher
than vasculopathy (38.6% Vs 10.2%)than vasculopathy (38.6% Vs 10.2%)
Age (p<0.01), duration of diabetesAge (p<0.01), duration of diabetes
(p<0.001) and glycemic control(p<0.001) and glycemic control
(p<0.01)are significantly correlated to(p<0.01)are significantly correlated to
high-risk feethigh-risk feet
Barefoot walking (p<0.001) and level ofBarefoot walking (p<0.001) and level of
education (p<0.0002) are important riskeducation (p<0.0002) are important risk
factorsfactors