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Risk Categorization of Diabetic Foot in Patients with Type-II Diabetes and Relationship of Various Risk Factors with Risk Categories of Diabetic Foot

Background: Diabetes is the leading cause of nontraumatic amputation. Foot screening which detects and stratification of diabetics which are at the risk of developing diabetic foot ulcer is the simple and useful part of this model of care. 
Aims: Primary Aim: To stratify patients with type II diabetes into different risk categories of diabetic foot as per International Diabetic Federation guidelines. 
Secondary Aim: To determine the relationship of various risk factors with risk categories of diabetic foot. 
Study Design: Cross sectional study. 
Place and Duration of Study: Department of Medicine, Liaquat University Hospital Jamshoro / Hyderabad from February 2019 to August 2020. 
Methodology: This study included 117 consecutive patients with confirmed diagnosis of Type-II diabetes of either sex ≥ 18 years of age. 
Patients fulfilling above criteria were included in study. Feet were thoroughly examined for neuropathy, peripheral vascular disease, infections, ulcers and osteoarthropathy. All the data was recorded on proforma. Patients having normal protective sensations were put in low risk (category 0), those having loss of protective sensations in moderate risk (category 1), those having loss of protective sensations with either high pressure or poor circulation or structural foot deformities or onychomycosis in high risk (category 2) and those having past history of ulceration, amputation or neuropathic fracture were put in very high risk (category 3). Data was analyzed by using SPSS version. 20. 
Results: Total 117 patients of diabetic foot ulcer were studied, their mean age was 52.28±9.26 years, diabetic duration 10.21±8.10 years and mean HbA1c level was 10.07±1.96 mmol/l. Male were in majority 52.1%. Ulceration history was in 18.8% cases, amputation history was in 7.7% cases, 46 patients (39.3%) had risk category 1. A strong relationship was found between risk categories and age, sex, duration of diabetes, HBA1c. 
Conclusion: This study revealed that 33 (28%) patients attending the diabetic clinic were at high risk of developing diabetic ulcer.