title: Diabetic foot complications and their risk factors from a large retrospective cohort study.
abstract: BACKGROUND
  Foot complications are considered to be a serious consequence of diabetes mellitus, posing a major medical and economical threat. Identifying the extent of this problem and its risk factors will enable health providers to set up better prevention programs. Saudi National Diabetes Registry (SNDR), being a large database source, would be the best tool to evaluate this problem.
  
  
  METHODS
  This is a cross-sectional study of a cohort of 62,681 patients aged ≥ 25 years from SNDR database, selected for studying foot complications associated with diabetes and related risk factors.
  
  
  RESULTS
  The overall prevalence of diabetic foot complications was 3.3% with 95% confidence interval (95% CI) of (3.16%-3.44%), whilst the prevalences of foot ulcer, gangrene, and amputations were 2.05% (1.94%-2.16%), 0.19% (0.16%-0.22%), and 1.06% (0.98%-1.14%), respectively. The prevalence of foot complications increased with age and diabetes duration predominantly amongst the male patients. Diabetic foot is more commonly seen among type 2 patients, although it is more prevalent among type 1 diabetic patients. The Univariate analysis showed Charcot joints, peripheral vascular disease (PVD), neuropathy, diabetes duration ≥ 10 years, insulin use, retinopathy, nephropathy, age ≥ 45 years, cerebral vascular disease (CVD), poor glycemic control, coronary artery disease (CAD), male gender, smoking, and hypertension to be significant risk factors with odds ratio and 95% CI at 42.53 (18.16-99.62), 14.47 (8.99-23.31), 12.06 (10.54-13.80), 7.22 (6.10-8.55), 4.69 (4.28-5.14), 4.45 (4.05-4.89), 2.88 (2.43-3.40), 2.81 (2.31-3.43), 2.24 (1.98-2.45), 2.02 (1.84-2.22), 1.54 (1.29-1.83), and 1.51 (1.38-1.65), respectively.
  
  
  CONCLUSIONS
  Risk factors for diabetic foot complications are highly prevalent; they have put these complications at a higher rate and warrant primary and secondary prevention programs to minimize morbidity and mortality in addition to economic impact of the complications. Other measurements, such as decompression of lower extremity nerves, should be considered among diabetic patients.
authors.affiliation: University Diabetes Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Khalid
authors.initials: K
authors.lastname: Al-Rubeaan
authors.affiliation: Diabetic Foot Unit, University Diabetes Center, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Al Derwish
authors.affiliation: Diabetic Foot Unit, University Diabetes Center, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Samir
authors.initials: S
authors.lastname: Ouizi
authors.affiliation: Registry Department, University Diabetes Center, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Amira M
authors.initials: AM
authors.lastname: Youssef
authors.affiliation: Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Shazia N
authors.initials: SN
authors.lastname: Subhani
authors.affiliation: Registry Department, University Diabetes Center, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Heba M
authors.initials: HM
authors.lastname: Ibrahim
authors.affiliation: Internal Medicine Department, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Bader N
authors.initials: BN
authors.lastname: Alamri
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D017719:Diabetic Foot / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012529:Saudi Arabia / Q000453:epidemiology; D012737:Sex Factors