Risk factors for diabetic foot ulcer recurrence: A prospective 2-year follow-up study in Egypt

• Published in: Foot (Edinburgh, Scotland) Scotland), 2018-06, Vol.35, p.11-15
• Main Author: Khalifa, Walaa A.
• Format: Article
• Language: English
• Subjects: Aged; Cohort Studies; Combined Modality Therapy - methods; Comorbidity; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - drug therapy; Diabetic Foot - diagnosis; Diabetic Foot - etiology; Diabetic Foot - therapy; Disease Management; Egypt; Female; Follow-Up Studies; Humans; Logistic Models; Lost ankle reflex; Male; Middle Aged; Multivariate Analysis; Peripheral arterial disease; Prospective Studies; Recurrence; Recurrent ulceration; Risk Factors; Severity of Illness Index; Smoking; Smoking - adverse effects; Smoking - epidemiology; Time Factors; Treatment Outcome; Type 2 diabetes; Wound Healing - physiology
• ISSN: 0958-2592; 1532-2963
• DOI: 10.1016/j.foot.2017.12.004

•The frequency rate of recurrent foot ulceration was 61.3% among patients with type 2 diabetes.•Increased rates of recurrent ulceration were observed despite regular education and follow up.•Independent risk factors were smoking, poor glycemic control, lost ankle reflex , peripheral arterial disease and previous ulcer location.•Socio-cultural habits and low economical levels impede the use of appropriate footwear and proper foot care in my locality. To determine the frequency of diabetic foot ulcer recurrence and its potential risk factors. This study included 93 patients with type 2 diabetes and followed for 2 years after primary healed foot ulceration. Demographic, diabetes related, comorbid and ulcer related variables were investigated as risk factors. Multiple logistic regression analysis was used to identify independent risk factors. 61.3% of patients had recurrent ulcers particularly in the forefoot (33.3%) and big toe (24.6%). Peripheral neuropathy, peripheral arterial disease or both were reported in 69%, 12% and 19% of feet with recurrent ulcers respectively. In multivariate analysis, the significant independent potential risk factors for recurrence of foot ulcers were smoking (P=0.040), poor glycemic control [HbA1c cutoff of 10%] (P=0.010), peripheral neuropathy with lost ankle reflex (P=0.0001), peripheral arterial disease (P=0.0001) and previous ulcer location (P=0.050). The frequency rate of recurrent diabetic foot ulceration in patients with type 2 diabetes is high particularly in the first year despite regular follow-up and patient education.