Predictors of diabetic foot and leg ulcers in a developing country with a rapid increase in the prevalence of diabetes mellitus.
OBJECTIVE
To identify the socio demographic, life style and foot examination related predictors of diabetic foot and leg ulcers with a view to develop a screening tool appropriate for the use in an outpatient setting.


METHODS
This cross sectional study included type 2 diabetes mellitus (DM) patients; 88 subjects with leg and foot ulcers and 80 non ulcer controls. Socio demographic data and life style factors were documented. Foot was examined for skin changes and structural abnormalities. Distal peripheral neuropathy was assessed by pressure sense, vibration sense and joint position sense. Multivariate analysis by logistic regression was used to determine the significant predictors in screening for foot ulcers.


RESULTS
Education of grade 6 and below (OR--1.41, 95% CI; 1.03-4.68), low income (OR--23.3, 95% CI; 1.5-34.0), impaired vibration sense (OR--24.79, 95% CI; 9.3-66.2), abnormal monofilament test on first (OR--1.69, 95% CI; 1.36-16.6), third (OR--3.4, 95% CI; 1.1-10.6) and fifth (OR--1.8, 95% CI; 1.61-12.6) toes are found to be predictors of increased risk whereas incidental diagnosis of DM (OR--0.03, 95% CI; 0.003-0.28), wearing covered shoes (OR--0.003, 95% CI; 0.00-0.28), presence of normal skin color (OR--0.01, 95% CI; 0.001-0.14) and normal monofilament test on first metatarsal head (OR--0.10, 95% CI; 0.00-0.67) are protective factors for ulcers.


CONCLUSIONS
Ten independent risk and protective factors identified in this study are proposed as a simple screening tool to predict the risk of developing leg and foot ulcers in patients with DM.
Department of Health Sciences, the Open University of Sri Lanka, Nawala, Sri Lanka.
Kumarasinghe A
KA
Sriyani
Sudharshani
S
Wasalathanthri
Priyadharshika
P
Hettiarachchi
Shamini
S
Prathapan
D003430:Cross-Sectional Studies; D003906:Developing Countries / Q000706:statistics & numerical data; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D017719:Diabetic Foot / Q000453:epidemiology*; D003929:Diabetic Neuropathies / Q000453:epidemiology; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence