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1362572658 dr. neeta deshpande

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dr. neeta deshpande

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1362572658 dr. neeta deshpande

  1. 1. PREVALENCE OF RISKPREVALENCE OF RISK FACTORS FOR DIABETICFACTORS FOR DIABETIC FOOT ULCER AND RISKFOOT ULCER AND RISK STRATIFICATION IN TYPE 2STRATIFICATION IN TYPE 2 DIABETESDIABETES DR. NEETA DESHPANDEDR. NEETA DESHPANDE ASSOCIATE PROF.,JNASSOCIATE PROF.,JN MEDICAL COLLEGE AND KLEMEDICAL COLLEGE AND KLE HOSPITAL, BELGAUMHOSPITAL, BELGAUM
  2. 2. INTRODUCTIONINTRODUCTION 40-70% of LL amputations related to40-70% of LL amputations related to DMDM Substantial emotional, physical andSubstantial emotional, physical and financial lossesfinancial losses Illiteracy, lack of knowledgeIlliteracy, lack of knowledge Largely preventable through earlyLargely preventable through early detection of “high-risk” feet,detection of “high-risk” feet, preventive footwear and counselingpreventive footwear and counseling
  3. 3. AIMS AND OBJECTIVESAIMS AND OBJECTIVES To know prevalence of risk factorsTo know prevalence of risk factors for diabetic foot ulceration andfor diabetic foot ulceration and stratification into risk categoriesstratification into risk categories To correlate risk categories to age,To correlate risk categories to age, duration of DM, glycemic control andduration of DM, glycemic control and SESSES
  4. 4. INCLUSION CRITERIAINCLUSION CRITERIA All known cases of type 2 DM of moreAll known cases of type 2 DM of more than 1 year durationthan 1 year duration
  5. 5. EXCLUSION CRITERIAEXCLUSION CRITERIA Patients with current foot ulcerPatients with current foot ulcer Patients of DM admitted for otherPatients of DM admitted for other neurological causesneurological causes
  6. 6. METHODOLOGYMETHODOLOGY 215 type 2 diabetics who were215 type 2 diabetics who were willing to participate in the studywilling to participate in the study were questioned in detail – age,were questioned in detail – age, duration of diabetes, footwearduration of diabetes, footwear practices, level of education,practices, level of education, symptoms of neuropathy,symptoms of neuropathy, vasculopathy, previous footvasculopathy, previous foot ulcer/amputationulcer/amputation Thorough foot examination was doneThorough foot examination was done Blood sample was collected forBlood sample was collected for HbA1cHbA1c
  7. 7. Definitions of recorded dataDefinitions of recorded data HISTORY OF FOOT ULCER – HealedHISTORY OF FOOT ULCER – Healed foot ulcer of more than 3 monthsfoot ulcer of more than 3 months durationduration HISTORY OF LL AMP – Non-traumaticHISTORY OF LL AMP – Non-traumatic amp at any level in the LLamp at any level in the LL PAD – Intermittent claudication orPAD – Intermittent claudication or h/o reconstructive vascular surgeryh/o reconstructive vascular surgery and/or absence of foot pulsesand/or absence of foot pulses
  8. 8. Definitions of recorded data - contdDefinitions of recorded data - contd SENSORY NEUROPATHY -SENSORY NEUROPATHY - >> 1 “no1 “no response” to 10 g MF applied to 10response” to 10 g MF applied to 10 sites (9 plantar and 1 dorsal) and/orsites (9 plantar and 1 dorsal) and/or NDSNDS FOOT DEFORMITY – hallux valgus,FOOT DEFORMITY – hallux valgus, overlapping toes, fixed clawed toes,overlapping toes, fixed clawed toes, pes cavus/planus, Charcot foot,pes cavus/planus, Charcot foot, prominent metatarsal headsprominent metatarsal heads
  9. 9. NEUROPATHY DISABILITYNEUROPATHY DISABILITY SCORE – RIGHT AND LEFTSCORE – RIGHT AND LEFT VibrationVibration sensesense (dorsum of big toe)(dorsum of big toe) : Present=0,: Present=0, reduced/absent=1reduced/absent=1 Pin prickPin prick :: Present=0,Present=0, reduced/absent=1reduced/absent=1 Ankle jerkAnkle jerk :: present=0, presentpresent=0, present onon reinforcement=1,reinforcement=1, absent=2absent=2 TOTAL SCORE:TOTAL SCORE: 3-4 Mild neuropathy3-4 Mild neuropathy 5-7 Moderate5-7 Moderate 8-10 Severe8-10 Severe
  10. 10. CLASSIFICATION OF INTERNATIONALCLASSIFICATION OF INTERNATIONAL WORKING GROUP ON DIABETIC FOOTWORKING GROUP ON DIABETIC FOOT RISK CATEGORYRISK CATEGORY 00 11 22 33 DESCRIPTIONDESCRIPTION No sensoryNo sensory neuropathyneuropathy Sensory neuropathySensory neuropathy onlyonly SN+PVD &/orSN+PVD &/or deformitydeformity PreviousPrevious ulcer/amputationulcer/amputation
  11. 11. Statistical MethodsStatistical Methods .Chi – square test and unpaired ‘t’ test.Chi – square test and unpaired ‘t’ test
  12. 12. Age and Sex distributionAge and Sex distribution AGEAGE MALEMALE FEMALEFEMALE TOTALTOTAL 45-5545-55 7070 3838 108108 56-6556-65 4242 3737 7979 66-7566-75 1818 44 2222 76-8576-85 44 22 0606 134134 8181 215215
  13. 13. Duration of diabetesDuration of diabetes 61 77 58 12 7 0 10 20 30 40 50 60 70 80 No.ofCases < 5 6 to 10 11 to 15 16 to 20 > 20 Duration of Diabetes
  14. 14. Prevalence of risk factorsPrevalence of risk factors CASESCASES PERCENTAGEPERCENTAGE NeuropathyNeuropathy 8383 38.638.6 VasculopathyVasculopathy 2222 10.2310.23 FootFoot deformitydeformity 1212 5.585.58 PrevPrev ulcer/ampulcer/amp 1010 4.654.65
  15. 15. Prevalence of risk factorsPrevalence of risk factors 83 22 12 10 0 10 20 30 40 50 60 70 80 90 No.ofCases Neuropathy Vasculopathy Foot deformities Previous ulcer or amputation Graph showing Prevalence of Neuropathy, Vasculopathy, Foot deformities and previous ulcer or amputation in the study population
  16. 16. Neuropathy Disability ScoreNeuropathy Disability Score No. Of CasesNo. Of Cases PercentagePercentage Mild (NDS 3-Mild (NDS 3- 4)4) 4545 54.2254.22 Mod (NDS 5-Mod (NDS 5- 7)7) 1616 19.2819.28 Severe (NDSSevere (NDS 8-10)8-10) 2222 26.5026.50
  17. 17. Mean duration of diabetesMean duration of diabetes Mean (Years)Mean (Years) SDSD Group 0Group 0 54.854.8 2.72.7 Group 1Group 1 1212 2.612.61 Group 2Group 2 17.517.5 1.451.45 Group 3Group 3 2121 3.623.62
  18. 18. Mean duration of diabetesMean duration of diabetes 5.8 12 17.5 21 0 5 10 15 20 25 Meandurationofdiabetes(Yrs) Group 0 Group 1 Group 2 Group 3 Graph showing mean duration of diabetes in each group distribution
  19. 19. Mean AgeMean Age 52.9 59.28 68.92 76 0 10 20 30 40 50 60 70 80 MeanAgeofthePatients (Yrs) Group 0 Group 1 Group 2 Group 3 Graph showing mean age of the patients in each group distribution
  20. 20. Glycemic controlGlycemic control HbA1cHbA1c GoodGood (<8%)(<8%) FairFair (8.1-(8.1- 10%)10%) PoorPoor (>10%)(>10%) Group 0Group 0 6464 2020 1616 Group 1Group 1 4343 4949 88 Group 2Group 2 2525 3333 4242 Group 3Group 3 1010 4040 5050
  21. 21. Glycemic controlGlycemic control 64 20 16 43 49 8 25 33 42 10 40 50 0 10 20 30 40 50 60 70 Percentage Group 0 Group 1 Group 2 Group 3 Graph showing Percentage of patients of different glycemic control in each group distribution Good Fair Poor
  22. 22. Barefoot walkingBarefoot walking 42 58 70 30 83 17 100 0 0 20 40 60 80 100 Percentage Group 0 Group 1 Group 2 Group 3 Graph showing Percentage of Bare foot walkers in each group distribution Present Absent
  23. 23. Level of educationLevel of education 44 45 43 49 32 19 75 17 8 100 0 0 0 20 40 60 80 100 Percentage Group 0 Group 1 Group 2 Group 3 Graph showing level of Education in group Iliterate Schooling College
  24. 24. ConclusionsConclusions Overall prevalence of neuropathy is higherOverall prevalence of neuropathy is higher than vasculopathy (38.6% Vs 10.2%)than vasculopathy (38.6% Vs 10.2%) Age (p<0.01), duration of diabetesAge (p<0.01), duration of diabetes (p<0.001) and glycemic control(p<0.001) and glycemic control (p<0.01)are significantly correlated to(p<0.01)are significantly correlated to high-risk feethigh-risk feet Barefoot walking (p<0.001) and level ofBarefoot walking (p<0.001) and level of education (p<0.0002) are important riskeducation (p<0.0002) are important risk factorsfactors

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