Non-vascular contributing factors of diabetic foot ulcer severity in national referral hospital of Indonesia

Abstract

Purpose: Diabetic foot ulcer (DFU) is a common chronic complication of type 2 diabetes mellitus (T2DM) in Indonesia, with a prevalence of 7.3%. However, the characteristics of these patients remain unclear. We investigated the characteristics of patients with DFU without peripheral arterial disease (PAD) and analyzed non-vascular factors related to severity of DFU in a tertiary care national referral hospital in Indonesia.

Methods: This was a cross-sectional study including 123 hemodynamically stable DFU patients without PAD recruited from Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia from 2010-2015.

Results: DFU patients were predominantly over 50 years old (75.6%) and diagnosed with T2DM for 5 years with poor glycemic control (82.7%) and peripheral neuropathy (91.3%). Most patients had anemia (86.7%), leukocytosis (84.6%), and were undernourished, as characterized by a low lipid profile (90.8%) and hypoalbuminemia (83.7%). Most had extensive size of ulcer at the initial visit, with a median size of 16.23 (2.92-60.16) cm². Ulcers were mostly located of the forefoot (62.5%) and were caused by mechanical trauma (46.2%). Bivariate analysis revealed that significant factors for the development of DFU were related to DFU size, including duration of T2DM (p = 0.04), leukocyte levels (p = < 0.01), and thrombocyte levels (p = < 0.01). Multivariate analysis showed leucocyte (p = 0.03) and thrombocyte (p = 0.023) had significantly correlated with DFU severity.

Conclusion: Leucocyte and thrombocyte may be the greatest contributing non-vascular factors for severity of DFU in Indonesia.

Keywords: Diabetic foot ulcer; Leucocyte; Non-vascular factor; Thrombocyte.

Fig. 1

Characteristics of diabetic foot ulcer. The location (a) and triggering event (b) of the diabetic foot ulcer are presented as percentages

Fig. 2

Association between non-vascular factors and diabetic foot ulcer size. Comparisons of diabetic foot ulcer size are presented as median (IQR). * p < 0.05 (independent t test). DFU, diabetic foot ulcer; eGFR,estimated glomerular filtration rate; LDL-C,low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol