Evaluation of factors responsible for advanced foot infection at index presentation among diabetic patients in South India

Abstract

Introduction: Foot ulcer is one of the most common and deadest complications of diabetes mellitus. Studies from India have shown that nearly 40% of patients with diabetic foot infection present with advanced foot infection at index presentation. This study aims to assess the factors which lead to severe diabetic infection at presentation in south India Methodology: The study was designed as Descriptive study and conducted in the Department of Surgery, JIPMER from June 2018 to July 2018. All patients more than 18 years of age presenting with Wagner’s diabetic foot infection grade 3 or more for the first time to casualty or outpatient department was included in the study. Patients with vasculopathy or Peripheral vascular disease, neuropathic joint and coexisting venous pathology were excluded. Demographic parameters, diabetes disease characteristics and treatment details, diabetic foot infection characteristics and prior treatment details were obtained. Using a self-administered questionnaire, knowledge about diabetic foot care, practice of foot care, details of the nearest health facility and compliance to primary treatment after the onset of diabetic foot infection were assessed. These parameters were correlated with the severity of diabetic foot infection at presentation and assessed for statistical significance. Results: A total of 60 patients presenting with Wagner’s diabetic foot infection grade 3 or more for the first time were recruited in the study. The mean age of the patients included in the study was 53.92. 73% (44) of patients were men and 81.67% (49) belonged to low socioeconomic status. 31% (19) of the study population were illiterate. 51 patients (85%) had an index presentation at other health centers before coming to JIPMER. On assessing the knowledge of the patients out of a maximum score of 9, 26.67% (16) scored less than 3 while 31.67% scored above 6. On questioning about their practice of foot care, only 6 patients checked their feet once a week or less while no one checked it every day twice and 86.67% told that they checked only when they had a problem. More than 50% of the patients walk bare footed. Conclusion: Higher grade diabetic foot infections are present in higher age group patients with long duration of diabetic and diabetic foot ulcers. Low socioeconomic status, inadequate knowledge of diabetic foot care and poor practice of diabetic foot care have been identified in patients with advanced diabetic foot infection.