1. Regression coefficient (b) RESULTS AND DISCUSSION
A Case Control Study of Diabetic Foot Ulcer in Kelantan Ninin Sukminingrum*, Sam’an M. Masudi*, Ab Azis Al Safi Ismail** *School of Dental Sciences, Universiti Sains Malaysia **School of Medical Sciences, Universiti Sains Malaysia
ABSTRACT
Table 2: Diabetes Mellitus Profile Data
Variable
Case (n=72)
Control (n=216)
Mean (SD)
Freq. (%)
DM type
Type I
2 (2.8)
3 (1.4)
Type II
70 (97.2)
213 (98.6)
DM duration
12.8 (6.38)
13.1 (7.73)
Treatment type
Mixed
19 (26.4)
13 (6.0)
Insulin
21 (29.2)
73 (33.8)
History of foot ulcer No
6 (8.3)
215 (99.5)
Yes
66 (91.7)
1 (0.5)
History of amputation
47 (65.3)
216 (100.0)
25 (34.7%)
Current foot ulcer
1 (1.4%)
214 (99.1)
71 (98.6%)
2 (0.9)
Latest HbA1c
<7
18 (25.0)
104 (48.1)
>7
54 (75.0)
112 (51.9)
Objectives: The aim of this study was to describe the characteristics of diabetic foot ulcer patients in Kelantan and determine its associated factors. Methods: This is a retrospective study and case control study. The case are Diabetic patients with foot ulcer and the control are Diabetic patients with no foot ulcer. Data were obtain from record list of diabetic patient with foot ulcer and without foot ulcer who were attended to HUSM from 2009 to Identified records from record office database were screen for inclusion and exclusion criteria. Systematic random sampling was applied for each group. A total of 288 sample from 72 as a case DM with foot ulcer and 216 as a control of DM. Data entry and statistical analysis using PASW version This study was approved by Human Ethic Committee of Universiti Sains Malaysia. Results: Diabetic Foot Ulcer (DFU) case mostly found in male, Malay, jobless, have duration of DM for more than 12 years, on Oral Anti Diabetic (OAD), usually have history of DFU or amputation, neuropathy complication, also orther complication of retinopathy. Data also shown that Coronary Heart Disease (CHD) and Cerebro Vascular Disease (CVD) complications are less in DFU. Conclusion: Prevention of DFU need proper treatment, target HbA1c less than 7 and foot care to avoid patients from neuropathy, foot ulcer and amputation.
criteria. Systematic random sampling was applied for each group. A total of 288 sample from 72 as a case DM with foot ulcer and 216 as a control of DM. Data entry and statistical analysis using PASW version Descriptive Statistic was used to determine the characteristic of variables which are numerical , in mean (SD) and categorical, in n (%). Multiple logistic regression analysis was used to evaluate factors associated with diabetic foot ulcer. This study was approved by Human Ethic Committee of Universiti Sains Malaysia.
INTRODUCTION
Diabetes Mellitus is global health burden. It is estimated that 346 million people have diabetes worldwide (WHO, 2011). In Malaysia, the prevalence of diabetes keeps increasing from 6.3% (NHMS I, 1986) to 8.3% (NHMS II, 1996) then 11.6% (NHMS III, 2006). A total of 11.7% Kelantan population has diabetes (NHMS III, 2006). Foot ulcer is one of the common complications arise from diabetes mellitus. In a population based study in Norway, foot ulcers among diabetes is 10.4% (Iversen et al, 2008). It is reported that the prevalence of foot ulcers among diabetic patient in Malaysia is 9.5% (Rabia, 2007). Altered foot sensation, foot deformities, and previous foot ulcer or amputation of the other foot are strong predictors for foot ulceration (altered sensation: RR 2.2, 95% CI 1.5 to 3.1; foot deformity; RR 3.5, 95% CI 1.2 to 9.9; previous foot ulcer: RR1.6, 95% CI 1.2 to 2.3; previous amputation: RR 2.8, 95% CI 1.8 to 4.3 (Boyko, 1999).
Table 3: History Foot ulcer or amputation on DFU
Variables
Regression coefficient (b)
Adjusted OR (95% CI of OR)
LR statistic (df)
P value
History of amputation No 1
Yes
2.58
13.22 (3.156, )
12.47 (1)
<0.001
size
<3cm
>3cm
2.75
15.56 (2.969, )
10.50 (1)
0.001
Color
2.48
11.93 (1.611, )
5.89 (1)
0.015
RESULTS AND DISCUSSION
Table 1: Sociodemography
Variable
Case (n=72)
Control (n=216)
Mean (SD)
Frequency (%)
Age
62.1 (10.10)
65.3 (10.79)
Gender
Male
40 (55.6)
105 (48.6)
Female
32 (44.4)
111 (51.4)
Race
Malay
68 (93.4)
201 (93.1)
Others
4 (6.6)
15 (6.9)
Occupation
Government
3 (4.2)
37 (17.1)
Self employment
15 (20.8)
36 (16.7)
Executive
1 (0.5)
Not working
54 (75.0)
142(65.7)
Smoking status
Non smoker
7 (9.7)
133 (61.6)
Ex smoker
43 (59.7)
45 (20.8)
Current smoker
22 (10.2)
Unknown
19 (26.4)
16 (7.4)
Table 4: Diabetes Mellitus Complications on DFU
Variable
Case (n=72)
Control (n=216)
Mean (SD)
Frequency (%)
Coronary Heart Disease No
46 (63.9)
81 (37.5)
Yes
26 (36.1)
135 (62.5)
Cerebro-Vascular Disease
57 (79.2)
192 (88.9)
15 (20.8)
24 (11.1)
Retinopathy
39 (54.2)
134 (62.0)
33 (45.8)
82 (38.0)
Nephropathy
34 (47.2)
133 (61.6)
38 (52.8)
83 (38.4)
Neuropathy
3 (4.2)
198 (91.7)
69 (95.8)
18 (8.3)
Amputation status
Case (n =72)
Control (n =216)
No amputated
43 (59.72%)
213 (98.6%)
Amputated
29 (40.28%)
3 (1.4%)
PURPOSE
The aim of this study was to describe the characteristics of diabetic foot ulcer patients in Kelantan and the data could be used for prevention purposes.
MATERIALS AND METHODS
Diabetic Foot Ulcer (DFU) case in Kelantan mostly found in male, Malay, jobless, have duration of DM for more than 12 years, on Oral Anti Diabetic (OAD), usually have history of DFU or amputation, neuropathy complication, also orther complication of retinopathy and nephropathy. Data also shown that Coronary Heart Disease (CHD) and Cerebro Vascular Disease (CVD) complications are less in DFU patients.
This is a retrospective study and case control study. The case are Diabetic patients with foot ulcer and the control are Diabetic patients with no foot ulcer. Data were obtain from record list of diabetic patient with foot ulcer and without foot ulcer who were attended to HUSM from 2009 to Identified records from record office database were screen for inclusion and exclusion
CONCLUSION
Prevention of DFU need proper treatment, target HbA1c less than 7 and foot care to avoid patients from neuropathy, foot ulcer and amputation.