Risk of diabetic foot ulcer and its associated factors among Bangladeshi subjects: a multicentric cross-sectional study

Palash Chandra Banik, Lingkan Barua, Mohammad Moniruzzaman, Rajib Mondal, Farhana Zaman, Liaquat Ali, Palash Chandra Banik, Lingkan Barua, Mohammad Moniruzzaman, Rajib Mondal, Farhana Zaman, Liaquat Ali

Abstract

Objective: To assess the risk of diabetic foot ulcer (DFU) and find out its associated factors among subjects with type 2 diabetes (T2D) of Bangladesh.

Design, setting and participants: This cross-sectional study recruited 1200 subjects with T2D who visited 16 centres of Health Care Development Project run by Diabetic Association of Bangladesh.

Primary and secondary outcome measures: Risk of DFU was assessed using a modified version of International Working Group on the Diabetic Foot (IWGDF) Risk Classification System. The modified system was based on five parameters, namely peripheral neuropathy (PN), peripheral arterial diseases (PAD), deformity, ulcer history and amputation. The risks were categorised as group 0 (no PN, no PAD), group 1 (PN, no PAD and no deformity), group 2A (PN and deformity, no PAD), group 2B (PAD), group 3A (ulcer history) and group 3B (amputation). The associated factors of DFU risk were determined using multinomial logistic regression for each risk category separately.

Results: Overall, 44.5% of the subjects were found 'at risk' of DFU. This risk was higher among men (45.6%) than women and among those who lived in rural areas (45.5%) as compared with the urban population. According to IWGDF categories, the risk was distributed as 55.5%, 4.2%, 11.6%, 0.3%, 20.6% and 7.9% for group 0, group 1, group 2A, group 2B, group 3A and group 3B, respectively. The associated factors of DFU (OR >1) were age ≥50 years, rural area, low economic status, insulin use, history of trauma, diabetic retinopathy and diabetic nephropathy.

Conclusion: A significant number of the subjects with T2D under study were at risk of DFU, which demands an effective screening programme to reduce DFU-related morbidity and mortality.

Keywords: Bangladesh; International Working Group on the Diabetic Foot; diabetes and endocrinology; diabetic foot; diabetic foot ulcer; diabetic foot ulcer risk.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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