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RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
10
VOLUME 17 NUMBER 1 • JULY 2020
Prevalence of diabetic neuropathy and risk factors for
diabetic foot ulcers among patients in a tertiary health
institution
MICHAEL ADEYEMI OLAMOYEGUN, AKINYELE TAOFIQ AKINLADE, GBADEBO OLADIMEJI AJANI,
EMMANUEAL YEMI FAGBEMIRO
Correspondence to: Michael Adeyemi Olamoyegun
Department of Medicine; Endocrinology, Diabetes & Metabolism Unit,
College of Health Sciences, Ladoke Akintola University of Technology/
LAUTECH Teaching Hospital, Ogbomoso, Oyo State, Nigeria
e-mail:
maolamoyegun@lautech.edu.ngAkinyele Taofiq Akinlade
Department of Medicine, General Hospital, Odan, Lagos, Nigeria
Gbadebo Oladimeji Ajani
Department of Medicine, Federal Teaching Hospital, Afe Babalola University,
Ado-Ekiti, Nigeria
Emmanuel Yemi Fagbemiro
Department of Medicine, Nile University of Abuja, Nigeria
S Afr J Diabetes Vasc Dis
2020;
17
: 10–14
Abstract
Background:
Diabetic foot is one of the most devastating
chronic complications of diabetes mellitus and is usually pre-
ceded by many risk factors, including peripheral neuropathy.
An understanding of these potential risk factors enables early
recognition and modification where possible. Hence this
study aimed to assess prevalence of peripheral neuropathy
and other risk factors for the development of diabetic foot.
Methods:
This study involved adults diagnosed with type
2 diabetes who were consecutively recruited from the
LAUTECH Teaching Hospital Diabetes Clinic, Ogbomoso,
Nigeria. Participants were surveyed for the presence of
foot ulcers, skin changes, deformities, dystrophic nails
and sensory neuropathy, using a 10-g Semmes-Weinstein
monofilament, 128-Hz tuning fork, diabetic neuropathy
symptoms score and diabetic neuropathy examination score.
Results:
The mean age was 62.08 ± 8.70 years and 47.5%
were male. Diabetes duration was 4.97 ± 4.10 years. The
prevalence of active foot ulceration among the study
participants was 14.4%. Diabetic peripheral neuropathy
(DPN) was diagnosed with monofilament insensitivity in
24.5% of patients, vibration insensitivity in 19.4%, no joint
position sense in 12.2%, diabetic neuropathy examination
in 15.1% and diabetic neuropathy symptoms score in 41.0%.
We found dry skin in 24.5%, claw toes in 19.4%, dystrophic
nails in 18.7%, calluses in 11.5% and gangrene in 4.3%.
Conclusion:
There was a high prevalence of DPN in our
patients, with a significant prevalence of diabetic foot ulcer
in 14.4%. It is suggested that regular screening for DPN
should be performed, with the aim of early recognition and
prevention of factors predisposing to foot ulceration.
Keywords:
prevalence, diabetic foot, peripheral neuropathy, risk
factors
Introduction
Diabetic foot, according to the World Health Organisation (WHO)
and the International Working Group on the Diabetic Foot, is
defined as ‘the foot of diabetic patients that has the potential risk
of pathologic consequences including ulceration, infection, and/or
destruction of deep tissues associated with neurologic abnormalities,
various degrees of peripheral vascular disease, and/or metabolic
complications of diabetes in the lower limb’.
1
In many developing
countries it is a major debilitating complication with severe morbidity
and possible amputations. Individuals with diabetes have a higher
risk of amputation than non-diabetic subjects.
2-5
Foot complications are one of the most frequent reasons for
hospitalisation in diabetes, accounting for up to 25% of all
admissions.
6,7
It has been estimated that 10 to 15% of diabetic
patients will develop a foot ulcer at some point in their lifetimes,
8-10
and that the risk of lower-extremity amputation is 15 to 40 times
higher in people with diabetes than in those without diabetes.
11
Up to 85% of foot amputations are preventable.
12
Foot ulcers
have been reported in a Nigerian population to occur after a mean
interval of 13 years from the diagnosis of diabetes.
13
Hospital-based studies demonstrated that the prevalence of limb
ulcerations in Nigeria was between 11.7 and 19.1%.
14,15
In Nigeria,
no sufficient data exist to help recognise the magnitude of the
risks for diabetic foot. A Nigerian study by Adigun and Olarinoye
examined the characteristics of patients with diabetic foot ulcers
attending an out-patient clinic at the University of Ilorin teaching
hospital. The investigator examined 105 diabetic patients, with a
mean age of 54 years, and found the prevalence of diabetic foot
ulceration to be 29.5%, callus 5.7% and cracked skin 11.4%.
16
Because of the high burden of diabetic foot ulceration and its
sequelae, identification of patients at risk for foot ulceration is of
paramount importance. This is because early detection with the
initiation of effective treatment has been shown to reduce the
prevalence of diabetic foot ulcerations and lesions by 44 to 85%.
17,18
Therefore, targeting patients at increased risk for developing foot
ulcers is believed to constitute a cost-effective strategy to control
progression to foot ulceration and amputation.
Diabetic peripheral neuropathy (DPN), which is defined as the
presence of symptoms and/or signs of peripheral nerve dysfunction
in patients with diabetes after exclusion of other causes,
19
is an
independent risk factor for foot ulceration and lower-extremity
amputation. It often presents with a loss of sensation on the foot
(sensory deficit), which can cause a patient to sustain an injury
without recognising any inciting trauma.
19
While the gold standard for diagnosis of DPN continues to be
a nerve conduction study (NCS), it is time consuming, requires a
separate patient visit and is costly. This cumbersome procedure