Foot status in diabetic patients attending the mulago hospital diabetic clinic.

Abstract

INTRODUCTION: Foot problems represent the most important of all long term complications of diabetes mellitus (D.M) medically, socially and economically. They have been documented in all parts of the world and extensively studied in Europe and north America. In Africa in general and Uganda in particular, little is known about the extent of the problem of foot complications in D.M and few studies on the subject have been published with none from Uganda reported. OBJECTIVES: The aim of this study was to assess the foot status of patients attending the H.H.D.C by determining the prevalence of high risk feet, the most common risk factors for foot ulceration / amputation and the most common foot lesions in these patients. The study also aimed at identifying the factors associated with foot ulceration/ amputation in addition to assessing the quality of foot care received by the patients. DESIGN: Descriptive cross-sectional study with an analytical component STUDY SETTING: The mulago hospital diabetic clinic in kampala, Uganda. METHODOLOGY: Three hundred patients selected by systematic random sampling had their social-demographic and clinical characteristics including the foot examination and laboratory findings recorded in a questionnaire. The number of patients with high risk-feet, foot lesions and risk factors for foot ulceration/ amputation were documented. Factors associated with foot ulceration/ amputation was determined by comparing a number of characteristics in patients with foot ulceration and in those without. The level of foot care was determined by interviewing the patients. RESULTS: All the 300 patients entered into this study had analyzable data. Of these 60% were found to have high risk feet while 99.7% of the patients had at least one risk factor for foot ulceration/ amputation. The most common risk factors were inappropriate foot ware, neuropathy and poor glycemic control. About 70% of the patients had foot lesions with dermatological lesions being the most common. Absent foot pulses, insensitivity to monofilament and higher H.D.L cholesterol levels were the factors found to be significantly associated with foot ulceration/ amputation. Most patients had not been taught about foot care and did not know how to care for their feet. CONCLUSION: A Significant proportion of patients were found to have high risk feet while almost all patients had at least one risk factor for foot ulceration/ amputation. Foot lesions were also common among patients attending the M.H.D.C and the level of foot care received by the patients was below the required standards. RECOMMENDATIONS: The level of health education and preventive foot care offered to patients attending the M.H.D.C needs to be improved. If possible a specialized foot care clinic should be set up.