References
Risk categorisation of patients attending a diabetic foot screening clinic in Suez
Abstract
Objective:
To identify risk factors and assess diabetic foot ulcer (DFU) and amputation risk category (according to the 2015 International Working Group on the Diabetic Foot (IWGDF) guidance) among patients with type 2 diabetes in the Suez governorate, Egypt.
Method:
A cross-sectional study was conducted in the diabetic foot screening clinic of Suez General Hospital. A comprehensive sample of patients with type 2 diabetes attending the diabetes clinic every Saturday were enrolled in the study. Patients were divided into four groups according to their history and foot examination: without neuropathy (Group 0); with neuropathy (Group 1); with neuropathy associated with deformity and/or vascular disorders (Group 2); and with foot ulcer or amputation history (Group 3).
Results:
A total of 220 patients were included in the study. Mean age of participants was 54.6±10.3 years and 70.5% of patients were female. The patients were divided into four groups: 37.3% were in group 0; 37.7% in group 1; 11.8% were in group 2; and 13.2% were in group 3. Male sex and diabetic complications (particularly neuropathy, cardiovascular disease and retinopathy) had the most significant effect on risk classification.
Conclusion:
This study showed that 62.7% of patients with diabetes enrolled in the study were at risk of developing a DFU and amputation. Physicians should conduct a foot assessment and risk categorisation for all patients with diabetes as early management or referral could prevent further complications.
Diabetes is a growing public health problem in Egypt, with the prevalence of type 2 diabetes among adults in 2021 at 18.4 %.1 Diabetic foot is defined by the International Working Group on the Diabetic Foot (IWGDF) as ‘infection, ulceration or destruction of tissues of the foot associated with neuropathy and/or peripheral artery disease in the lower extremity of a person with (a history of) diabetes mellitus'.2
The International Diabetes Federation (IDF) mainly attributes diabetic foot disease to neuropathy, peripheral arterial disease (PAD) and/or infection, often leading to ulceration and possible subsequent limb amputation. This can result in an economic, social and public health burden, especially in low-income communities, if there is neither an appropriate educational programme for patients about foot care and when to visit a physician, nor adequate and suitable protective or therapeutic footwear.3
The World Health Organization (WHO) has stated that diabetic foot is one of the costliest complications of diabetes, especially in communities with a lack of availability of appropriate footwear. It results from both vascular and neurological disease processes—changes in blood vessels and nerves—often leading to ulceration and subsequent limb amputation. Regular inspection and effective and timely foot care can prevent amputations.4 The use of comprehensive foot care programmes, including early screening and evaluation of problems, foot care education, preventive therapy and referral to specialists, has been shown to reduce amputation rates by 49–85%.5
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