Moderate prevalence of foot ulceration risk according to the IWGDF guidelines in type 2 diabetic patients attending the primary health care
DOI:
https://doi.org/10.24265/horizmed.2018.v18n4.02Keywords:
Prevalence, Foot, Diabetes mellitus type 2, Risk factorsAbstract
Objective: To determine the prevalence of foot ulceration risk (FUR) according to the International Working Group on the Diabetic Foot (IWGDF) guidelines, demonstrated by the presence of peripheral diabetic neuropathy (PDN) and/or peripheral arterial disease (PAD) and/or deformity (D), as well as its associated factors, in type 2 diabetic patients attending the primary health care (PHC) in Trujillo. Materials and methods: A sample of 301 type 2 diabetic patients was collected from public and private health centers of the district of Trujillo belonging to the PHC. Subsequently, said sample was stratified according to the IWGDF guidelines on foot at risk, considering diagnoses such as PDN, PAD and D. Descriptive and analytical statistics were performed with the variables evaluated by the IBM SPSS Statistics V22.0. In addition, accreditation was requested from an ethics and research committee. Results: Type 2 diabetic patients showed the following diagnoses: 13.3 % presented PDN, 18.6 % PAD and 64.1 % D. Besides, it was found that 86.7 % have no FUR, 4 % are at slight risk of and 9.3 % are at moderate risk of developing foot ulcers, with a total prevalence of 13.3 %. Finally, the associated risk factors were medical attention frequency, hypertension, hypoglycemia, physical activity and orthopedic footwear. Conclusions: This is the only epidemiological study performed in the Peruvian PHC showing a moderate prevalence of FUR, but lower than its Latin-American peers’ experiences. Deformity was the most frequent component, and positive and very weak associated factors were found when analyzing patients with and without risk factors.
Downloads
References
Cavan D, Fernandes J, Makaroff L, Ogurtsova K, Webber S. Diabetes Atlas. 7th. ed. New York: International diabetes Federation; 2015:24-31. https://www.idf.org/e-library/epidemiology-research/diabetes-atlas.html
Grupo para el consenso de pie diabético. Guía de pie diabético. Revista del ALAD. 2010; 18(2):73-84. http://www.alad-americalatina.org/documentos-de-consenso-de-la-alad/
Ramos W, López T, Revilla L, More L, Huamani M, Pozo M. Resultados de la vigilancia epidemiológica de Diabetes mellitus en hospitales notificantes del Perú, 2012. Rev Peru Med Exp Salud Pública. 2014; 31(1):9-15.
Rodríguez D. Manual médico quirúrgico de pie diabético experiencia de la costa norte del Perú. 1ra. ed. Trujillo: Colegio Médico del Perú; 2014:3-6.
Monteiro-Soares M, Vaz-Carneiro A, Sampaio S, Dinis- Ribeiro M. Validation and comparison of currently available stratification systems for patients with diabetes by risk of foot ulcer Development. Eur J Endocrinol. 2012; 167(3): 401– 407.
Monteiro-Soares M, Boyko EJ, Ribeiro J, Ribeiro I, Dinis- Ribeiro M. Risk stratification systems for diabetic foot ulcers: a systematic review. Diabetologia. 2011; 54:1190–1199.
Monteiro-Soares M, Boyko EJ, Ribeiro J, Ribeiro I, Dinis- Ribeiro M. Predictive factors for diabetic foot ulceration: a systematic review. Diabetes Metab Res Rev. 2012; 28(7):574- 600.
Alonso-Fernández M, Mediavilla-Bravo JJ, López-Simarro F, Comas-Samper JM, Carramiñana-Barrera F, Mancero-Romero J, et al . Evaluación de la realización del cribado del pie diabético en Atención Primaria. Endocrinol Nutr. 2014; 61(6): 311-317.
Boulton A, Vileikyte A. Painful Diabetic Neuropathy in Clinical Practice. 1st. ed. Heidenberg: Springer; 2011:1-39.
Schaper NC, Andros G, Apelqvist J, Bakker K, Lammer J, Lepantalo M, et al. Specific guidelines for the diagnosis and treatment of peripheral arterial disease in a patient with diabetes and ulceration of the foot 2011. Diabetes Metab Res Rev. 2012; 28(1): 236–237.
Formosa C, Gatt A and Chockalingam N. The importance of clinical biomechanical assessment of foot deformity and joint mobility in people living with type-2 diabetes within a primary care setting. Prim Care Diabetes. 2013; 7(1): 45–50.
Hinchliffe RJ, Brownrigg JR, Apelqvist J, Boyko EJ, Fitridge R, Mills JL, et al. IWGDF guidance on the diagnosis, prognosis and management of peripheral artery disease in patients with foot ulcers in diabetes. Diabetes Metab Res Rev. 2016 ;32(1):37-44.
Schaper NC, Van Netten JJ, Apelqvist J, Lipsky BA, Bakker K; International Working Group on the Diabetic Foot. Prevention and management of foot problems in diabetes: a Summary Guidance for Daily Practice 2015, based on the IWGDF Guidance Documents. Diabetes Metab Res Rev. 2016; 32 (1):7- 15.
Bortoletto MS, De Andrade SM, Matsuo T, Haddad Mdo C, González AD, Silva AM. Risk factors for foot ulcers—A cross sectional survey from a primary care setting in Brazil. Prim Care Diabetes. 2014; 8(1): 71-76.
Álvarez Seijas E, Mena Bouza K ,Faget Cepero O, Coneza Gonzales AI, Dominguez Alonso E. El pie de riesgo de acuerdo con su estratificación en pacientes con diabetes mellitus. Rev Cubana Endocrinol. 2015; 26(2):158-171.
Cueva Recalde JF. Validación del puntaje de riesgo para ulcera en pie diabético del SIGN en un grupo de pacientes en Quito. Av Diabetol. 2009; 25:486-90.
Damas-Casani VA, Yovera-Aldana M , Seclén Santisteban S. Clasificación de pie en riesgo de ulceración según el Sistema IWGDF y factores asociados en pacientes con diabetes mellitus tipo 2 de un hospital peruano. Rev Med Hered. 2017; 28(1):5- 12.
Bus SA, van Netten JJ, Lavery LA, Monteiro Soares M, Rasmussen A, Jubiz Y, et al. IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes. Diabetes Metab Res Rev. 2016;32 (1):16-24.
Abramczyk A. Results of specialized ambulatory diabetes care among diabetes patients at the level of primary health care--in the light of nationwide research. Adv Clin Exp Med. 2012;21(1):63-8
Arredondo A, Azar A, Recamán AL. Diabetes, a global public health challenge with a high epidemiological and economic burden on health systems in Latin America. Glob Public Health. 2018;13(7):780-787.
Del Brutto OH, Mera RM, King NR, Zambrano M, Sullivan LJ. The burden of diabetes-related foot disorders in community- dwellers living in rural Ecuador: Results of the Atahualpa Project. Foot. 2016; 28:26-29.
Santos Thomazelli F, Machado C, Dolçan K. Análise do risco de pé diabético em umambulatório interdisciplinar de diabetes. Rev AMRIGS. 2015; 59(1):10-14.
Crews RT, Schneider KL, Yalla SV, Reeves ND, Vileikyte L. Physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers: a critical review. Diabetes Metab Res Rev. 2016;32(8):791-804.
Sämann A, Lehmann T, Heller T, Müller N, Hartmann P, Wolf GB, Müller UA. A retrospective study on the incidence and risk factors of severe hypoglycemia in primary care. Fam Pract. 2013;30(3):290-3.
Pereira Despaigne OL, Palay Despaigne MS, Frómeta Ríos V, Neyra Barrios RM. Efectividad de un programa educativo en pacientes con pie diabético de riesgo. MEDISAN. 2015;19(1):69-77.
Published
How to Cite
Issue
Section
License
Copyright (c) 2018 Horizonte Médico (Lima)

This work is licensed under a Creative Commons Attribution 4.0 International License.
Horizonte Médico (Lima) (Horiz. Med.) journal’s research outputs are published free of charge and are freely available to download under the open access model, aimed at disseminating works and experiences developed in biomedical and public health areas, both nationally and internationally, and promoting research in the different fields of human medicine. All manuscripts accepted and published in the journal are distributed free of charge under the terms of a Creative Commons license – Attribution 4.0 International (CC BY 4.0).