title: Predictors of diabetes foot complications among patients with diabetes in Saudi Arabia.
abstract: OBJECTIVE
  To identify risk factors and clinical biomarkers of prevalent diabetes foot complications, including foot ulcers, gangrene and amputations among patients with diabetes in Jeddah, Saudi Arabia.
  
  
  METHODS
  598 diabetes patients from Jeddah participated in the current study. Patients were considered to have diabetes foot complications if they reported diagnosis of foot ulcers or gangrene or amputations in a questionnaire administered by a physician and confirmed by clinical exams. Information on socio-demographic and lifestyle variables was self-reported by patients, and several clinical markers were assessed following standard procedures.
  
  
  RESULTS
  The prevalence of diabetes foot complications in this population was 11.4%. In the multivariable model without adjustment for PAD (peripheral artery disease) and DPN (diabetes peripheral neuropathy), non-Saudi nationality, longer diabetes duration and insulin use was significantly associated with higher diabetes foot complications prevalence. Each 1g/L increase of hemoglobin was associated with 2.8% lower prevalence of diabetes foot complications. In the multivariable model adjusting for PAD and DPN, the previously observed associations except for nationality were no longer significant. Patients with both DPN and PAD had 9.73 times the odds of diabetes foot complications compared to the patients with neither condition.
  
  
  CONCLUSIONS
  In this population, longer diabetes duration, insulin use, lower hemoglobin levels and non-Saudi nationality were associated with higher prevalence of foot complications. These associations were largely explained by the presence of DPN and PAD except for non-Saudi nationality. Diabetes patients with both DPN and PAD had nearly 10-fold increased risk of foot complications than those with neither condition.
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Brigham & Women's Hospital, Boston, MA, United States.
authors.forename: Yang
authors.initials: Y
authors.lastname: Hu
authors.affiliation: The Mohammad Hussein Al Amoudi Chair for Diabetic Foot Research, Jeddah, Saudi Arabia; Department of Nutrition and Food Sciences, Jeddah, Saudi Arabia.
authors.forename: Balkees A
authors.initials: BA
authors.lastname: Bakhotmah
authors.affiliation: The Mohammad Hussein Al Amoudi Chair for Diabetic Foot Research, Jeddah, Saudi Arabia.
authors.forename: Owiss H
authors.initials: OH
authors.lastname: Alzahrani
authors.affiliation: Department of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA, United States.
authors.forename: Dong
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA, United States; The Channing Division for Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States. Electronic address: frank.hu@channing.harvard.edu.
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.affiliation: The Mohammad Hussein Al Amoudi Chair for Diabetic Foot Research, Jeddah, Saudi Arabia; Department of Surgery, King Abdulaziz University (KAU), Jeddah, Saudi Arabia. Electronic address: haaz59@yahoo.com.
authors.forename: Hasan A
authors.initials: HA
authors.lastname: Alzahrani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D017719:Diabetic Foot / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D013997:Time Factors
keywords: Amputations; Diabetes; Diabetes foot complications; Foot gangrene; Foot ulcers; Saudi Arabia