A study of risk factors in the development of diabetic foot: 1N campaign

Authors

  • Claudia Marcela Issa Sanatorio Güemes, Autonomous City of Buenos Aires, Argentina
  • Gabriela Verónica Carro Alejandro Posadas National Hospital, Province of Buenos Aires, Argentina
  • Rubén Nicolás Saurral Municipal Hospital of Trauma and Emergencies Dr. Federico Abete, Center for Diabetes and Metabolic Diseases Dr. A. Maggio, Province of Buenos Aires, Argentina
  • Elizabet Gladys Méndez Dr. Ramón Madariaga Acute School Hospital/Preventive Medicine Center (HEADRM/PREDIGMA), Posadas, Misiones, Argentina
  • Claudio Fabián Dituro General Viamonte Municipal Hospital, HIGA Junín Diabetic Foot Clinic, Province of Buenos Aires, Argentina
  • Javier Aníbal Vilte Hospital San Roque, Integral Center for Diabetic Care, San Salvador de Jujuy, Jujuy, Argentina
  • María Cristina Varela Hospital Central de San Isidro, Province of Buenos Aires, Argentina
  • Raúl Alejandro David Alfredo I. Perrupato Hospital, San Martín, Mendoza, Argentina
  • Érica Lorena Witman Clinic of Ulcers and Diabetic Foot, Government Assistance Establishment Centeno, La Pampa, Argentina
  • Julio César Torres Regional Hospital of Río Grande, Tierra del Fuego, Argentina
  • Rocío Zabala Julio C. Perrando Hospital, Resistencia, Chaco, Argentina
  • Gabriela Silvana Illuminati Image Clinic, Center for Endocrinology and Ría (CER), Neuquén, Argentina
  • María Alejandra Casen Zenón Santillán Health Center Hospital, San Miguel de Tucumán, Tucumán, Argentina
  • Pablo Alterini San Martín Hospital, Paraná, Entre Ríos, Argentina
  • María Victoria Dicatarina Losada Sommer Hospital, Province of Buenos Aires, Argentina
  • Sandra Aixa Kremer Sendros J. R. Vidal Hospital, Corrientes, Argentina
  • Florencia Cuto Private University Hospital of Córdoba, Córdoba, Argentina
  • Florencia Badías Provincial Hospital of Rosario, Private Hospital of Rosario, Santa Fe, Argentina
  • José Daniel Braver Hospital de Clínicas, Autonomous City of Buenos Aires, Argentina
  • Luisa Mabel Carrió Municipal Diabetes Center Dr. Alberto Maggio and of the Malvinas Argentinas Diabetes Foot Day Hospital, Province of Buenos Aires, Argentina
  • Lucía Belén Jiménez Güemes Sanatorium, Autonomous City of Buenos Aires, Argentina
  • Jaqueline Norma Castillo Güemes Sanatorium, Autonomous City of Buenos Aires, Argentina
  • Javier Mauricio Farías Güemes Sanatorium, Autonomous City of Buenos Aires, Argentina

DOI:

https://doi.org/10.47196/diab.v55i1.468

Keywords:

diabetic foot, diabetic neuropathy, screening, diabetes mellitus, complications.

Abstract

Introduction: foot examination is essential in patients with diabetes mellitus (DM). The correct evaluation of the foot in the patient who attends diabetes control is key to establish risk factors for the development of ulcers, detect injuries, take preventive measures, make an early referral and educate in foot care.

Objectives: in this study, the feet of people with DM were examined during the Diabetic Foot Awareness and Prevention Campaign on November 1, 2019 in order to assess the presence of symptoms and signs related to neuropathy, peripheral vascular disease, prevalence of the same and know the risk.

Materials and methods: 165 patients were analyzed in four centers: Sanatorio Güemes (Diabetes and Endocrinology Service), PREDIGMA (Preventive Medicine Center, Posadas, Misiones), Central Hospital of San Isidro, Nexo Medical Center (Junín City) and Hospital Municipal of General Viamonte (Province of Buenos Aires).

Results: it was found that 43.6% had some symptoms in the lower limbs and up to 57% had an alteration in the screening tests for diabetic neuropathy or peripheral arterial disease, with a higher prevalence the longer the evolution of DM.

The most frequent signs found in the physical examination were: dry skin (71.5%), nail dystrophy (60.6%) or alteration of the foot pad (52.1%). The most frequent comorbidities were: hypertension (74.5%) and dyslipidemia (73.3%). The median glycated hemoglobin was 7.40% (6.70-8.10), higher in people with a history of retinopathy (7.8%; p <0.01) and in patients who reported having cramps (7, 85 to 7.30; p = 0.03) or burning (8.0 vs 7.3; p <0.01).

The percentage of patients with high-risk foot due to antecedents, inspection or screening for neuropathy or vascular disease represented from 40% in those with DM of less than five years of evolution to 86% in those who were older than 20 years.

Conclusions: this high percentage of patients with foot at risk identified in this study suggests that, in addition to the correct physical examination, the attending physician requires the taking of behaviors, such as the indication of appropriate footwear or insoles, as well as a fluid referral to the orthotic technician, orthopedic surgeon, or physiatrist.

Author Biographies

Claudia Marcela Issa, Sanatorio Güemes, Autonomous City of Buenos Aires, Argentina

Physician, specialist in Internal Medicine, Nutrition, Master in Diabetes, Diploma in wound healing; Diabetes and Diabetic Foot Clinic Coordinator, Endocrinology and Diabetes Service Sanatorio Güemes; Member of the Diabetic Foot Committee of the Argentine Diabetes Society

Gabriela Verónica Carro, Alejandro Posadas National Hospital, Province of Buenos Aires, Argentina

Physician, specialist in Internal Medicine, Master in Diabetes, Diabetic Foot Unit, Professor Alejandro National Hospital; Member of the Diabetic Foot Committee of the Argentine Diabetes Society; Delegate International Working Group on the Diabetic Foot (IWGDF) for Argentina

Rubén Nicolás Saurral, Municipal Hospital of Trauma and Emergencies Dr. Federico Abete, Center for Diabetes and Metabolic Diseases Dr. A. Maggio, Province of Buenos Aires, Argentina

Physician, Nutrition specialist, Master in Diabetes; Member of the Diabetic Foot Committee of the Argentine Diabetes Society, Municipal Trauma and Emergency Hospital Dr. Federico Abete, Center for Diabetes and Metabolic Diseases Dr. A. Maggio

Elizabet Gladys Méndez, Dr. Ramón Madariaga Acute School Hospital/Preventive Medicine Center (HEADRM/PREDIGMA), Posadas, Misiones, Argentina

Physician, specialist in Internal Medicine and Diabetes (Argentine Diabetes Society); Member of the Diabetic Foot Committee of the Argentine Diabetes Society, Hospital Escuela de Acudos Dr. Ramón Madariaga/Center for Preventive Medicine (HEADRM/PREDIGMA)

Claudio Fabián Dituro, General Viamonte Municipal Hospital, HIGA Junín Diabetic Foot Clinic, Province of Buenos Aires, Argentina

Physician, specialist in General and Comprehensive Medicine, Master in Diabetes; Member of the Diabetic Foot Committee of the Argentine Diabetes Society, Diabetology Service, Centro Junín Clinic, Gral. Viamonte Municipal Hospital, HIGA Junín Diabetic Foot Clinic

Javier Aníbal Vilte, Hospital San Roque, Integral Center for Diabetic Care, San Salvador de Jujuy, Jujuy, Argentina

Physician, specialist in Endocrinology; Member of the Diabetic Foot Committee of the Argentine Diabetes Society, San Roque Hospital, Comprehensive Diabetic Care Center

María Cristina Varela, Hospital Central de San Isidro, Province of Buenos Aires, Argentina

Physician, specialist in Nutrition, University of Buenos Aires (UBA); Member of the Diabetic Foot Committee of the Argentine Diabetes Society, Hospital Central de San Isidro

Raúl Alejandro David, Alfredo I. Perrupato Hospital, San Martín, Mendoza, Argentina

Physician, specialist in Internal Medicine, Nutrition and Diabetes; Member of the Diabetic Foot Committee of the Argentine Diabetes Society, Hospital Alfredo I. Perrupato

Érica Lorena Witman, Clinic of Ulcers and Diabetic Foot, Government Assistance Establishment Centeno, La Pampa, Argentina

Physician, Nutrition specialist, special Diabetology qualification (High Council of La Pampa); Member of the Diabetic Foot Committee of the Argentine Diabetes Society, Diabetic Foot and Ulcer Clinic, Government Assistance Establishment. Rye

Julio César Torres, Regional Hospital of Río Grande, Tierra del Fuego, Argentina

Generalist and Family Physician, Master in Diabetes, Diploma in wound healing; Member of the Diabetic Foot Committee of the Argentine Diabetes Society, Diabetes and Metabolism Service, Río Grande Regional Hospital

Rocío Zabala, Julio C. Perrando Hospital, Resistencia, Chaco, Argentina

Physician, specialist in Nutrition and Diabetes, Master in Human Nutrition; Member of the Diabetic Foot Committee of the Argentine Diabetes Society, Julio C. Perrando Hospital

Gabriela Silvana Illuminati, Image Clinic, Center for Endocrinology and Ría (CER), Neuquén, Argentina

Physician, specialist in Internal Medicine; Member of the Diabetic Foot Committee of the Argentine Diabetes Society, Imaging Clinic, Endocrinology and Estuary Center (CER)

María Alejandra Casen, Zenón Santillán Health Center Hospital, San Miguel de Tucumán, Tucumán, Argentina

Physician, specialist in Endocrinology; Member of the Diabetic Foot Committee of the Argentine Diabetes Society, Hospital Centro de Salud Zenón Santillán

Pablo Alterini, San Martín Hospital, Paraná, Entre Ríos, Argentina

Physician, Cardiovascular Surgeon; Member of the Diabetic Foot Committee of the Argentine Diabetes Society, Hospital San Martín

María Victoria Dicatarina Losada, Sommer Hospital, Province of Buenos Aires, Argentina

Physician, specialist in Internal Medicine, Diploma in Diabetology (University of Business and Social Sciences, UCES); Member of the Diabetic Foot Committee of the Argentine Diabetes Society, Hospital Sommer

Sandra Aixa Kremer Sendros, J. R. Vidal Hospital, Corrientes, Argentina

Physician, specialist in Medical Clinic and Diabetes; Member of the Diabetic Foot Committee of the Argentine Diabetes Society, Endocrinology Nutrition and Diabetes Service, Hospital J. R. Vidal

Florencia Cuto, Private University Hospital of Córdoba, Córdoba, Argentina

Physician, specialist in Internal Medicine, expert in Diabetes; Member of the Diabetic Foot Committee of the Argentine Diabetes Society, Diabetology and Nutrition Service, Private University Hospital of Córdoba

Florencia Badías, Provincial Hospital of Rosario, Private Hospital of Rosario, Santa Fe, Argentina

Physician, specialist in Medical Clinic; Member of the Diabetic Foot Committee of the Argentine Diabetes Society, Rosario Provincial Hospital, Rosario Private Hospital

José Daniel Braver, Hospital de Clínicas, Autonomous City of Buenos Aires, Argentina

Physician, specialist in Endocrinology; Member of the Diabetic Foot Committee of the Argentine Diabetes Society; Director of the Diabetic Foot Program, Hospital de Clínicas, Vice President of the International Working Group on the Diabetic Foot (IWGDF)

Luisa Mabel Carrió, Municipal Diabetes Center Dr. Alberto Maggio and of the Malvinas Argentinas Diabetes Foot Day Hospital, Province of Buenos Aires, Argentina

Physician, specialist in Internal Medicine, Master in Diabetes, Diploma in wound healing; Director of the Dr. Alberto Maggio Municipal Diabetes Center and the Malvinas Argentinas Diabetic Foot Day Hospital, Province of Buenos Aires; Coordinator of the Diabetic Foot Committee of the Argentine Diabetes Society

Lucía Belén Jiménez, Güemes Sanatorium, Autonomous City of Buenos Aires, Argentina

Physician, specialist in Internal Medicine and Diabetes

Jaqueline Norma Castillo, Güemes Sanatorium, Autonomous City of Buenos Aires, Argentina

Physician, specialist in Internal Medicine and Endocrinology

Javier Mauricio Farías, Güemes Sanatorium, Autonomous City of Buenos Aires, Argentina

Physician, specialist in Internal Medicine and Endocrinology; Head of the Endocrinology and Diabetes Service

References

I. Boulton A. The diabetic foot: grand overview, epidemiology and pathogenesis. Diabetes Metab Res Rev 2008; 24:S3-S6.

II. Rodríguez-Bolaños RA, Reynales-Shigematsu LM, Giménez-Ruiz JA, et al. Costos directos de atención médica en pacientes con diabetes mellitus tipo 2: análisis de microcosteo. Rev Pan Salud Pub 2010; 28:412-420.

III. Hicks C, Selvin E. Epidemiology of peripheral neuropathy and lower extremity disease in diabetes. Curr Diab Rep 2019; 19(10):86

IV. Ruiz M. Diabetes mellitus. Cuarta edición. Ed AKADIA. 2011.

V. Pop-Busui R, Boulton A, Feldman E, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care 2017; 40(1):136-154.

VI. Hinchliffe R, Fortsythe R, Apelqvist J, et al. IWGDF guidelines on diagnosis, prognosis and management of peripheral arterial disease in patients with a foot ulcer and diabetes. Disponible en: https://iwgdfguidelines.org/pad-guideline/. Consulta: octubre de 2020.

VII. Gibbons G, Shaw P. Diabetic vascular disease: Characteristics of vascular disease unique to the diabetic patient. Semin Vasc Surg 2012; 25:89-92.

VIII. Pedrosa H, Campillo N, Braver J, Antonucci R, Jubiz Y, Barragan D. Consenso pie diabético ALAD-GEPLED. Revista de la Sociedad Argentina de Diabetes 2013;47: 93-114.

IX. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA 2005; 293:217-228.

X. Bus S, Lavery L, Monteiro-Soares M, Rasmussen A, Raspovic A, Sacco I, et al. IWGDF guidelines on the prevention and management of diabetic foot disease 2019. Disponible en: https://iwgdfguidelines.org/wp-content/uploads/2019/05/02-IWGDF-prevention-guideline-2019.pdf. Consulta: octubre de 2020.

XI. Ibrahim A, Jude E, Langton K, et al. IDF clinical practice recommendations on the diabetic foot 2017. Disponible en: https://www.idf.org/about-diabetes/54-our-activities/222-idf-clinical-practice-recommendations-on-the-diabetic-foot.html. Consulta: octubre de 2020.

XII. Takahashi O, Sakakibara R, Tateno F, Aiba Y. Diabetic neuropathy: distribution pattern revisited. Case Rep Neurol 2020; 12:160-164.

XIII. Domínguez C, Flores C, Fuente G, et al. Actualización del tratamiento de la polineuropatía diabética periférica dolorosa 2015. Comité de Neuropatía Diabética. Sociedad Argentina de Diabetes. Revista de la Sociedad Argentina de Diabetes 2016; 50:35-46.

XIV. Moss SE, et al. The prevalence and incidence of lower extremity amputation in a diabetic population WESDR. Arch Intern Med 1992; 152:610-616.

XV. Carro G, Saurral R, Salvador F, et al. Pie diabético en pacientes internados en Hospitales de Latinoamérica. Medicina (Buenos Aires) 2018; 78:243-251.

XVI. Miller J, Carter E, Shih J, et al. How to do a 3-minute diabetic foot exam. The Journal of Family Practice 2014; 63:646-656.

XVII. Dorresteijn J, Kriegsman D, Assendelft W, et al. Patient education for preventing diabetic foot ulceration. Cochrane Database Syst Rev 2014; (12):CD001488.

XVIII. Sharma S, Kerry C, Atkins H, et al. The Ipswich touch test: a simple and novel method to screen patients with diabetes at home for increased risk of foot ulceration. Diabet Med 2014; 31(9):1100-1103.

Published

2021-04-01

How to Cite

Issa, C. M., Carro, G. V., Saurral, R. N., Méndez, E. G., Dituro, C. F., Vilte, J. A., Varela, M. C., David, R. A., Witman, Érica L., Torres, J. C., Zabala, R., Illuminati, G. S., Casen, M. A., Alterini, P., Dicatarina Losada, M. V., Kremer Sendros, S. A., Cuto, F., Badías, F., Braver, J. D., Carrió, L. M., Jiménez, L. B., Castillo, J. N., & Farías, J. M. (2021). A study of risk factors in the development of diabetic foot: 1N campaign. Journal of the Argentine Society of Diabetes, 55(1), 04–12. https://doi.org/10.47196/diab.v55i1.468

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