Predicting the risk of future diabetic foot ulcer occurrence: a prospective cohort study of patients with diabetes in Tanzania

Naemi, Roozbeh; Chockalingam, Nachiappan; Lutale, Janet K; Abbas, Zulfiqarali G

Abstract

Objectives: The aim of this study was to identify the
parameters that predict the risk of future foot ulcer
occurrence in patients with diabetes.
Research design and methods: 1810 (male (M)/
female (F): 1012/798) patients, with no foot ulcer at
baseline, participated in this study. Data from a set of 28
parameters were collected at baseline. During follow-up,
123 (M/F: 68/55) patients ulcerated. Survival analyses
together with logistic regression were used to identify
the parameters that could predict the risk of future
diabetic foot ulcer occurrence.
Results: A number of parameters (HR (95% CI)) including
neuropathy (2.525 (1.680 to 3.795)); history of ulceration
(2.796 (1.029 to 7.598)); smoking history (1.686 (1.097
to 2.592)); presence of callus (1.474 (0.999 to 2.174));
nail ingrowth (5.653 (2.078 to 15.379)); foot swelling
(3.345 (1.799 to 6.218)); dry skin (1.926 (1.273 to
2.914)); limited ankle (1.662 (1.365 to 2.022)) and
metatarsophalangeal (MTP) joint (2.745 (1.853 to
4.067)) ranges of motion; and decreased (3.141 (2.102
to 4.693)), highly decreased (5.263 (1.266 to 21.878)),
and absent (9.671 (5.179 to 18.059)) sensation to
touch; age (1.026 (1.010 to 1.042)); vibration perception
threshold (1.079 (1.060 to 1.099)); duration of diabetes
(1.000 (1.000 to 1.000)); and plantar pressure at the first
metatarsal head (1.003 (1.001 to 1.005)), temperature
sensation (1.019 (1.004 to 1.035)) and temperature
tolerance (1.523 (1.337 to 1.734)) thresholds to hot
stimuli and blood sugar level (1.027 (1.006 to 1.048))
were all significantly associated with increased risk of
ulceration. However, plantar pressure underneath the fifth
toe (0.990 (0.983 to 0.998)) and temperature sensation
(0.755 (0.688 to 0.829)) and temperature tolerance
(0.668 (0.592 to 0.0754)) thresholds to cold stimuli
showed to significantly decrease the risk of future ulcer
occurrence. Multivariate survival model indicated that
nail ingrowth (4.42 (1.38 to 14.07)); vibration perception
threshold (1.07 (1.04 to 1.09)); dry skin status (4.48
(1.80 to 11.14)); and temperature tolerance threshold to
warm stimuli (1.001 (1.000 to 1.002)) were significant
predictors of foot ulceration risk in the final model.
The mean time to ulceration was significantly (p<0.05)
shorter for patients with: dry skin (χ2 =11.015), nail
ingrowth (χ2 =14.688), neuropathy (χ2 =21.284), or foot
swelling (χ2 =16.428).

Citation

Naemi, R., Chockalingam, N., Lutale, J. K., & Abbas, Z. G. (2020). Predicting the risk of future diabetic foot ulcer occurrence: a prospective cohort study of patients with diabetes in Tanzania. BMJ Open Diabetes Research and Care, 8, Article e001122. https://doi.org/10.1136/bmjdrc-2019-001122

• Journal Article Type: Article
• Acceptance Date: Mar 24, 2020
• Publication Date: 2020
• Deposit Date: Aug 21, 2024
• Publicly Available Date: Sep 19, 2024
• Journal: BMJ Open Diabetes Research and Care
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 8
• Article Number: e001122
• DOI: https://doi.org/10.1136/bmjdrc-2019-001122