Suvd.J
Lower
limb amputation and foot ulcer account for considerable morbidity, mortality,
and health care expenditures among patients with diabetes. For the diabetic
patients 25-80% have risk of diabetic
foot complication, 6-12% have foot ulcer them 85% are done foot amputation and we have opportunity to reduce
his foot amputation by 49-85% if we exist foot complication in the early stage
and treat them correctly. One complication of diabetes mellitus is foot
complication and its develops from lack of neurogenous and vascular supply and
it will get worse cutaneous and soft tissue, joint, arthrae disorders such are
acute or chronic purulent and necrosis process(WHO 1999).
Goal
To study risks for the diabetic foot complications
among type 2 diabetic patients.
Objectives
- To determine who have risk for the diabetic
foot complication in type 2 diabetic patients.
- To study the some risk factors of diabetic foot complication in type 2 diabetic patients.
- To value the risk degree who have risk for the diabetic foot
complication.
·
To define level and form of the diabetic foot
ulcer.
Material and methods The
study was carried out in UB- I, II, Achtan clinical hospital, Sukhbaatar,
Bayanzurkh, Chingeltei, Bayangol districts of Ulaanbaatar city.
A
total of 158 type 2 diabetic patients were randomly selected using the
questionnaire, anthropometric indices, blood pressure, blood sugar measurement
and clinical testing of peripheral neurophaty, peripheral vascular disease
based on WHO standard methods.
The
risk was determined in accordance with the modified recommendations of the
International Agreement on the Diabetic Foot. The computer program SPSS-15.0 is
used to process, unit database, check
and analyze the information.
Methodology
We
studied on the International Diabetes Federation and the study has 2 stages.
First stage:
·
Simple questionnaire – Patients passport
data, history of disease ( diabetes duration, history data on ulcerative detect
of the foot and or amputation were recorded.)
·
Anthropometric indices– Body weight, length,
body mass index, blood pressure .
·
Foot examination, to check foot peripheral
vascular disease and peripheral neuropathy and will check the risk who have diabetic foot complication and
value its degree.
·
Laboratory examination section identifying
outer fasting plasma glucose.
Second
stage: For the diabetic foot complication patients who were selected from the
first stage of the survey examination:
· Valued
the any risk factors who have risk for diabetic foot complication.
· Identifying
the risk degree who have risk for the diabetic foot complication.
· Identifying level and form of the diabetic foot ulcer.
Results
This
study included 158 type 2 diabetic patients over the 35 years old and from them
77(48.7%) male, 81(51.3%) female. The mean age of participants 54 ±10.4 years
and diabetes duration of 12 ± 4.6 years. Using diabetic foot complication
diagnosing new standard metods the patients 71(44.9%) were in risk of DFC and we can subdivide patients:
15(21.42%)- have peripheral neuropathy, 27(38.58%)- have peripheral vascular
disease, 29 (40.01%)- duplicated mixed form.
When
DFC risk level increases for the diabetic patients it has significance of
informing the risk degree of foot ulcer and foot amputation. The patients who
have DFC risk of high, medium and low is related to the DFC risk and from our
study 71 or 44.9% of participants are risk of DFC. Also no risk and low risk
degree diabetic patients were 55.06% and high risk patients were 13.93% and it
shows for our country diabetic patients have more risk of foot ulcer and amputation than other
country.
There
are 16 (10.1%) patients had foot ulcer, all were mixed form of DFC. As dividing
foot ulcer using Wagner classification: 1st rate complication
-6(37.5%), 2nd rate complication -4(25%), 3rd rate
complication -2(12.5%), 4th rate complication -2(12.5%), 5th
rate complication -2 (12.5%). And for the patients who have foot complication
62.5% are infected, 37.5% are osteomyelitis, and 25% are gangrene and from those 12.5% are foot fully
gangrened.
Conclusion
·
Our study 71 or 44.9% of participants have
risk of DFC.
·
For the
diabetic patients long diabetes duration, high blood pressure, reducing the
ankle brachial index are becoming the risk factors for the diabetic foot
complication.
·
For our country we have a lot of high risk
degree diabetic patients especially high 17.08% and extra high risk 13.93%
degree comparing to the other countries.
·
We had 10.1% patients with diabetic foot ulcer and all
were mixed form of DFC. As dividing foot ulcer using Wagner classification: 3rd
4th 5th rate complication 37.5%.
Key words: Diabetic foot
complication, peripheral vascular disease, peripheral neuropathy, foot ulcer,
foot amputation, osteomyelitis, gangrene
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