Diabetic Foot Burden: Experience at Diabetic Foot Care Clinic at Tertiary Care Hospital in Islamabad

Objectives: To determine the frequency of different types and grades of foot ulcers and their clinical outcome. Study Design: Descriptive Case Series. Place and Duration: Department of General Medicine, PIMS, Islamabad. Data collected for 09 months (March to November 2011) at diabetic foot care clinic. Materials and Methods: Total 101 adult diabetic patients having foot ulcers at the time of presentation were enrolled at diabetic foot care clinic PIMS. Foot ulcers were classified as neuropathic, neuro-ischemic and ischemic through detailed history, physical examination and investigations. Wound classification system proposed by University of Texas was used to ascertain grades (severity) of ulcers. All the patients were managed as per guidelines by International Working Group on the Diabetic Foot (IWGDF) and were followed up for outcome determination, which was defined as complete recovery, recovery with disability and death. Results: There were 29 patients who lost the follow up and hence excluded from the study. Out of remaining 72 (100%) subjects, 55.6% (n=40) were males and 44.4% (n=32) were females. Neuropathic ulcers were found in 51.3 % (n=37) of patients, neuro-ischemic in 43.1% (n=31) and ischemic ulcers were found in 5.6% (n=4) of patients. There were 65.3% (n=47) patients who recovered completely without any disability, 30.5% (n=22) patients recovered with disability (had minor or major amputation) and 4.2% (n=3) patients died during the course of treatment. There were 29.7% (n=11/37) neuropathic, 35.5% (n=11/31) neuro-ischemic and 75% (n=3/4) pure ischemic type ulcers, which resulted in clinically adverse outcome i.e., disability and death. Similar trend was seen with increasing grade (severity) of the ulcers. Conclusion: A significant number of people were having diabetic foot disease leading to high amputation rates in our study. Early detection with initiation of prompt treatment in this group and prevention in high-risk group through participation of public health department could reduce the overall burden of the diabetic foot disease and its complications in the region.