Presentation and outcome of diabetic foot at a tertiary care unit
Diabetes Mellitus, Type 1
Diabetes Mellitus, Type 2
Objectives: The prevalence of lower extremity amputation (LEA) is high in Pakistan, but the underlying risk factors remain to be defined. The purpose of this study was to define the presentation and risk factors determining outcome of diabetic foot ulceration leading to LEA in a tertiary care hospital in Karachi, Pakistan. Methodology: We have characterized the presenting features, grade of foot ulceration and risk factors for ulceration and LEA in 214 diabetic patients presenting with foot ulceration between January 1997 and December 2003 to a tertiary care unit in Karachi, Pakistan. Results: Seventeen (7.9%) patients had grade one, one hundred thirty three (62.1%) grade two and sixty four (29.9%) grade three ulceration. One hundred fifty five (72.43%) patients completely healed without LEA, while fifty nine (27.5%) patients underwent LEA. The risk of LEA was significantly associated with the grade of ulceration at presentation (p value=0.001), increasing age, and UT staging. Females presenting with foot ulceration had a higher BMI (P=0.0001), systolic (P=0.002) and diastolic (P=0.03) blood pressure and total cholesterol (P=0.03). Conclusion: The outcome of ulceration was determined by the severity and grade of foot ulceration at presentation. Despite a significant proportion of patients having an underlying neuroischaemic aetiology for foot ulceration, the majority healed. There was significant gender difference for risk factors for neuropathic ulceration.