title: Stratification of persons with diabetes into risk categories for foot ulceration.
abstract: BACKGROUND
  Patients with diabetes mellitus are at a higher risk of lower extremity complications as compared to their non-diabetic counterparts.
  
  
  OBJECTIVE
  To study risk factors for diabetic foot ulcer disease and stratify patients with diabetes into risk categories for foot ulceration.
  
  
  METHODS
  Cross-sectional descriptive study over five months period.
  
  
  METHODS
  Diabetic outpatient clinic, at the Kenyatta National Hospital.
  
  
  METHODS
  Two hundred and eighteen ambulatory subjects with diabetes mellitus without active foot lesions.
  
  
  RESULTS
  The prevalence of previous foot ulceration was 16% while that of previous amputation was 8%. Neuropathy was present in 42% of the study subjects and was significantly associated with age, male gender, duration of diabetes, random blood sugar, systolic blood pressure and the presence of foot deformity. Peripheral arterial disease was present in 12% and showed significant association with male gender. Foot deformities were observed in 46% of study subjects and were significantly associated with age, male gender, and presence of neuropathy. Subsequently 57% were categorised into IWGDF group 0--no neuropathy, 10% were placed in group 1--neuropathy alone, 16% were put in group 2--neuropathy plus either peripheral arterial disease or foot deformity and 17% were placed in risk group 3--previous foot ulceration/amputation.
  
  
  CONCLUSIONS
  More than one third (33%) of diabetic patients were found to be at high risk for future foot ulceration (IWGDF groups 2 and 3). Published evidence exists that shows improved outcomes with interventions targeting individual patients with diabetes at high-risk of foot ulceration. Long term prospective studies to determine outcomes for the different risk categories should be carried out locally.
authors.affiliation: Kenyatta National Hospital, P.O. Box 29774-00202, Nairobi, Kenya.
authors.forename: E
authors.initials: E
authors.lastname: Mugambi-Nturibi
authors.forename: C F
authors.initials: CF
authors.lastname: Otieno
authors.forename: T O O
authors.initials: TO
authors.lastname: Kwasa
authors.forename: G O
authors.initials: GO
authors.lastname: Oyoo
authors.forename: K
authors.initials: K
authors.lastname: Acharya
mesh_terms: D000554:Ambulatory Care Facilities; D055109:Ankle Brachial Index; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000145:classification*; D017719:Diabetic Foot / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D005530:Foot Deformities / Q000150:complications; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors