Prevalence of Risk Factors for Egyptian Diabetic Foot Ulceration .

Background: Diabetic foot ulcers (DFUs) contribute significantly to the morbidity and mortality of patients with diabetes mellitus. Foot ulceration is an important health issue with significant levels of disability, pain, and financial expense for those affected and the community as a whole. The diabetic patients with foot ulcers require long hospitalization and carry risk of limb amputation . The risk of ulcers is increased in people who have had diabetes ≥10 years, are male, have poor glucose control, or have cardiovascular, retinal, or renal complications. Fortunately, the modifiable risk factors for developing diabetic foot ulcers are preventable and manageable. Aim: The purpose of this study was to determine the prevalence of risk factors for foot ulceration in Egyptian diabetic patients. Settings: this study was conducted at different areas comprising upper and Lower Egypt as well as delta region (Assiut, Elmina, Kena, Aswan, Alexandria, and Mansura). Subjects: the study comprised a total of randomly selected one thousand adult diabetic patients with any type of diabetes, not taking any medications that might adversely influences their peripheral nerve function as chemotherapy and free from complications other than diabetes origin such as Parkinson's disease or Multiple Sclerosis. Tool: One tool was used for data collection of this study: Modified Inlow’s 60-second Diabetic Foot Screen. Two parts were attached to the study tool: Part I: Patients Socio-demographic data (age, gender, marital status, education level, occupation, and area of residence) and Patient's related medical data. Part II: Assessment of diabetic patient foot care related knowledge and Practices. Methods: Descriptive correlational research design was used in this study. Results: diabetic patients ages ranges from 18-65 years. The largest percentage (45.4) of patients was in age group of 50 years to less than 65. More than half (56.9 %) of the subjects had type 2 diabetes. More than onethird of the studied subjects (39.6 %) were smokers. Blood glucose levels of the diabetic subjects were elevated among two-thirds (64.4 %) of them. The findings of this study show that 38.9 % didn’t understand the effect of diabetes on their foot health. More than half (58.2 %) of them couldn’t identify appropriate foot care-related practices and already about (57.8) of the studied patients were not adequately cared for their feet. There are statistical significant differences between socio-demographic characteristics, medical data, assessment of patient foot care knowledge and practice and risk factors for studied subjects. Conclusion: the current study shows that 47.9 % have potential risk for diabetic foot ulcer. It moreover, reveals that patients with elevated blood glucose levels were 2.9 more likely to have foot ulcer, patients with inappropriate foot care practices were 2.1 more likely to have foot ulcer, and patients from Elmenia (one of Egyptian governorates) were 41.9 more likely to have foot ulcer compared with patients with maintained blood glucose levels, patients with appropriate foot care practices, and patients from other studied settings. The lack of knowledge regarding diabetic foot problems, inappropriate footwear and the high prevalence of skin and nail pathology in the study population could explain these findings. Recommendations: From the results of the present study it can be recommended that; nurses should instruct and emphasize the diabetic patients about the importance of knowledge and practices of foot care, appropriate footwear, podiatric care and regular follow up. Moreover, Nurses should adopt one of the low-cost effective and available strategies to identify the persons at risk for diabetic foot ulcers and the timely referral of those at high risk. Furthermore, formal and informal Organization of the Diabetes and foot-care service in Egypt should establish a global education programs that tailored to the patient's understanding and social background to manage an epidemic of foot abnormalities expected to be seen in the near future.