Sociodemographic and clinical characteristics of patients with diabetic foot ulcer.

INTRODUCTION Diabetic foot is one of the most serious complications of diabetes affecting about 15% of all diabetes patients, and it is the leading cause of nontraumatic lower limb amputations. This study presents a sociodemographic and clinical characterization of patients with diabetic foot ulcer indicated for amputation surgery. METHODS A cross-sectional study with 206 patients with type 2 diabetes and a diabetic foot ulcer indicated for amputation surgery. Patients were assessed on sociodemographic and clinical characteristics, pain intensity and pain interference, after answering the Brief Pain Inventory, and on pain descriptors according to the Douleur Neuropathique 4. RESULTS Most patients were male, with little formal education and a mean age of 66 years. They had been diagnosed with type 2 diabetes for 18 years in average, and diagnosed with diabetic foot ulcer in average 3 years prior to the assessment. About 59% of patients experienced pain in the lower limb that significantly interfered with all areas of their functioning. CONCLUSION The social demographic variables play an important role in diabetic foot ulceration. Given that the neuropathic ulcers are more easily preventable, systematic monitoring of patients with neuropathy is important. In patients with neuroischemic foot, strategies to cope or manage more efficiently the pain are paramount. Intervention should be multidisciplinary and take into account sociodemographic and clinical factors, as well as the presence, intensity and interference of pain in the patient's daily life activities and whether the patient has family or caregiver support.

[1]  S. Kono,et al.  Waist circumference and insulin resistance: a cross-sectional study of Japanese men , 2009, BMC endocrine disorders.

[2]  B. Stacey,et al.  Pain severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep. , 2005, Journal of pain and symptom management.

[3]  B. Snively,et al.  Diabetes Foot Self-care Practices in a Rural, Triethnic Population , 2005, The Diabetes educator.

[4]  C. Hartrick,et al.  The Numeric Rating Scale for Clinical Pain Measurement: A Ratio Measure? , 2003, Pain practice : the official journal of World Institute of Pain.

[5]  Bernard Laurent,et al.  Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4) , 2005, Pain.

[6]  M. Ghasemi-Rad,et al.  Comparison of demographic and clinical characteristics influencing health-related quality of life in patients with diabetic foot ulcers and those without foot ulcers , 2011, Diabetes, metabolic syndrome and obesity : targets and therapy.

[7]  D. Ziegler Painful Diabetic Neuropathy , 2009, Diabetes Care.

[8]  D. Armstrong,et al.  Off-loading the diabetic foot wound: a randomized clinical trial. , 2001, Diabetes care.

[9]  L. Uccioli,et al.  Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study , 2008, Diabetologia.

[10]  B. Galer,et al.  Painful diabetic polyneuropathy: epidemiology, pain description, and quality of life. , 2000, Diabetes research and clinical practice.

[11]  C. Cleeland,et al.  How to assess cancer pain. , 1992 .

[12]  Preventive Foot Care in People with Diabetes , 2000 .

[13]  G. Seghieri,et al.  Improvement of diabetic foot care after the Implementation of the International Consensus on the Diabetic Foot (ICDF): results of a 5-year prospective study. , 2007, Diabetes research and clinical practice.

[14]  M. Nortvedt,et al.  The association between history of diabetic foot ulcer, perceived health and psychological distress: the Nord-Trøndelag Health Study , 2009, BMC endocrine disorders.

[15]  N. Clark,et al.  Standards of Medical Care in Diabetes: Response to Power , 2006 .

[16]  J. Apelqvist,et al.  Health-related quality of life in patients with diabetes mellitus and foot ulcers. , 2000, Journal of diabetes and its complications.

[17]  T. Jensen,et al.  New perspectives on the management of diabetic peripheral neuropathic pain , 2006, Diabetes & vascular disease research.

[18]  Va Puget,et al.  Preventing foot ulcers in patients with diabetes , 2005 .

[19]  R. Rubin,et al.  Patient Interpretation of Neuropathy (PIN) Questionnaire , 2006, Diabetes Care.

[20]  L. J. Gonez,et al.  Progenitor cells in the adult pancreas , 2004, Diabetes/metabolism research and reviews.

[21]  P. Valensi,et al.  Quality of life and clinical correlates in patients with diabetic foot ulcers. , 2005, Diabetes & metabolism.

[22]  S. Paul,et al.  The Exploration of the Establishment of Cutpoints to Categorize the Severity of Acute Postoperative Pain , 2006, The Clinical journal of pain.

[23]  E. Block,et al.  Increased gait variability in diabetes mellitus patients with neuropathic pain. , 2013, Journal of diabetes and its complications.

[24]  M. G. Pereira,et al.  Partners’ representations of diabetes as mediators between patients’ representations and adherence to self-care behaviors, in type 2 diabetes , 2016, Psychology, health & medicine.

[25]  R. Rubin,et al.  Psychological aspects of diabetic neuropathic foot complications: an overview , 2004, Diabetes/metabolism research and reviews.

[26]  G. Jörneskog Why Critical Limb Ischemia Criteria are Not Applicable to Diabetic Foot and What the Consequences are , 2012, Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society.

[27]  S. Çınar Comparison of psychosocial adjustment in people with diabetes with and without diabetic foot ulceration , 2008 .

[28]  S. Kaplan,et al.  Are Type 2 diabetic patients offered adequate foot care? The role of physician and patient characteristics. , 2005, Journal of diabetes and its complications.

[29]  M. Gore,et al.  Sleep Impairment in Patients With Painful Diabetic Peripheral Neuropathy , 2005, The Clinical Journal of Pain.

[30]  L. Norgren,et al.  Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). , 2007, Journal of vascular surgery.

[31]  M. Hanefeld,et al.  Structured health care for subjects with diabetic foot ulcers results in a reduction of major amputation rates , 2013, Cardiovascular Diabetology.

[32]  W. Jeffcoate,et al.  Factors contributing to the presentation of diabetic foot ulcers , 1997, Diabetic medicine : a journal of the British Diabetic Association.

[33]  A. Boulton,et al.  The diabetic foot. , 1988, Clinics in dermatology.

[34]  Bernard Laurent,et al.  Prevalence of chronic pain with neuropathic characteristics in the general population , 2008, PAIN.

[35]  Soheila S. Kordestani,et al.  Diabetic foot ulcers. , 1977, Lancet.

[36]  J. Farrar,et al.  Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale , 2001, PAIN.

[37]  Khalil-ur-Rehman,et al.  Epidemiology and outcome in patients of diabetic foot. , 2011, Journal of Ayub Medical College, Abbottabad : JAMC.

[38]  C. K. Bowering Diabetic foot ulcers. Pathophysiology, assessment, and therapy. , 2001, Canadian family physician Medecin de famille canadien.

[39]  David J. Margolis,et al.  Economic burden of diabetic foot ulcers and amputations , 2011 .

[40]  J. Apelqvist,et al.  Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study , 2009, Diabetologia.

[41]  S. Gilbey Neuropathy and foot problems in diabetes. , 2004, Clinical medicine.

[42]  R. Heshmat,et al.  Who are diabetic foot patients? A descriptive study on 873 patients , 2013, Journal of Diabetes & Metabolic Disorders.

[43]  P. Cavanagh,et al.  Foot problems in diabetes: an overview. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[44]  M. G. Pereira,et al.  Family variables as moderators between beliefs towards medicines and adherence to self-care behaviors and medication in type 2 diabetes. , 2014, Families, systems & health : the journal of collaborative family healthcare.

[45]  K. Birkeland,et al.  A comparison of the health-related quality of life in patients with diabetic foot ulcers, with a diabetes group and a nondiabetes group from the general population , 2007, Quality of Life Research.

[46]  J. Richard,et al.  Factors associated with diabetic patients at high risk for foot ulceration. , 2005, Diabetes & metabolism.

[47]  M. G. Pereira,et al.  Patients’ and Spouses’ Contribution Toward Adherence to Self-Care Behaviors in Type 2 Diabetes , 2015, Research and Theory for Nursing Practice.

[48]  E. Trepman,et al.  Health-related quality of life in diabetic patients with foot ulcers: literature review. , 2005, Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society.

[49]  C A Bodian,et al.  The Visual Analog Scale for Pain: Clinical Significance in Postoperative Patients , 2001, Anesthesiology.

[50]  M. Criqui,et al.  Peripheral arterial disease detection, awareness, and treatment in primary care. , 2001, JAMA.

[51]  H. Mayer,et al.  Diabetes foot self-care practices in the German population. , 2008, Journal of clinical nursing.