1Эрүүл Мэндийн Шинжлэх Ухааны Их Сургууль, 2“Ачтан” Клиникийн эмнэлэг
A study of risks for the diabetic foot complications in type 2 diabetic patients
Lower limb amputation and foot ulcer account for considerable morbidity, mortality, and health care expenditures among patients with diabetes. For the diabetic patients 25-80% have risk of diabetic foot complication, 6-12% have foot ulcer them 85% are done foot amputation and we have opportunity to reduce his foot amputation by 49-85% if we exist foot complication in the early stage and treat them correctly.
Goal: To study risks for the diabetic foot complications (DFC) among type 2 diabetic patients.
Objectives:
1. To study the risk factors of DFC in type 2 diabetic patients
2. To value the risk degree who have DFC
3. To define level and form of the diabetic foot ulcer.
Material and methods: The study was carried out in UB- I, II, Achtan clinical hospital, Sukhbaatar, Bayanzurkh, Chingeltei, Bayangol districts of Ulaanbaatar city. A total of 158 type 2 diabetic patients were randomly selected using the questionnaire, anthropometric indices, blood pressure, blood sugar measurement and clinical testing of peripheral neurophaty, peripheral vascular disease based on WHO standard methods in 2 stages. The risk was determined in accordance with the modified recommendations of the International Agreement on the Diabetic Foot. The computer program SPSS-15.0 is used to process, unit database, check and analyze the information. First stage: 1. Questionnaire – Patients passport data, history of disease ( diabetes duration, history data on ulcerative detect of the foot and amputation were recorded.) 2. Anthropometric indices– Body weight, length, body mass index, blood pressure. 3. Foot examination, to check foot peripheral vascular disease and peripheral neuropathy and will check the diabetic foot complication and value its degree. 4. Laboratory examination section identifying outer fasting plasma glucose. Second stage: For the diabetic foot complication patients who were selected from the first stage of the survey examination. 1. Valued risk degree of diabetic foot complication 2. Identifying the diabetic foot complication type 3. Identifying level of the foot ulcer
Results: This study included 158 type 2 diabetic patients over the 35 years old and from them 77(48.7%) male, 81(51.3%) female. The mean age of participants 54 ±10.4 years and diabetes duration of 12 ± 4.6 years. Using diabetic foot complication diagnosing new standard metods the patients 71(44.9%) were in risk of DFC and we can subdivide patients: 15(21.42%)- had peripheral neuropathy, 27(38.58%)- had peripheral vascular disease, 29 (40.01%)- duplicated mixed form. When DFC risk degree increases for the diabetic patients it has significance of informing the risk degree of foot ulcer and foot amputation. The patients who have DFC risk of high, medium and low is related to the DFC risk and from our survey 71 or (44.9% of survey attendants ) are risk of DFC. Also no risk and low risk degree diabetic patients were 55.06% and high risk patients were 13.93% and it shows for our country diabetic patients have more risk of foot ulcer and amputation than other country. There are 16 (10.1%) patients had foot ulcer, all were mixed form of DFC. As dividing foot ulcer using Wagner classification: 1st rate complication -6(37.5%), 2nd rate complication -4(25%), 3rd rate complication -2(12.5%), 4th rate complication -2(12.5%), 5th rate complication -2 (12.5%). And for the patients who have foot complication 62.5% are infected, 37.5% are osteomielitis, and 25% are gangrene and from those 12.5% are foot fully gangrened.
Conclusion
1. For the diabetic patients long diabetes duration, high blood pressure, reducing the ankle brachial index are becoming the risk factors for the diabetic foot complication.
2. For our country we have a lot of high risk degree diabetic patients especially high and extra high risk degree comparing to the other countries.
3. We had 16 (10.1percent) patients with diabetic foot ulcer and 3.1% foot amputation from our study and it means we need to educate patients to prevent from peripheral neuropathy and peripheral vascular disease, establish for the “Diabetic Foot Room” and monitoring the DFC and provide them all need drugs, insulin and treatment materials.
Судалгааны ажлын үндэслэл
ОУДХ-ны судалгаанаас үзэхэд сүүлийн жилүүдэд чихрийн шижин өвчний тохиолдол тогтвортой ихсэх хандлагатай байна. Манай орны хувьд сүүлийн 20 жилд чихрийн
шижин өвчин (ЧШӨ) 5 дахин нэмэгдэж, уг өвчний тархалт 3.1%, глюкозын сорилд өөрчлөлттэй эмгэгийн тархалт 9.2% болох нь судалгаагаар
тогтоогджээ.1,2 ЧШӨ-ний хүндрэлүүдээс хамгийн элбэг тохиолдох хүндрэлүүдийн нэг нь хөлийн хүндрэл (ХХ) юм. Чихрийн шижинтэй өвчтөнүүдийн 25-80% ХХ үүсэх эрсдэлтэй, 6-12% хөлийн шархтай байгаа
бөгөөд эдгээрийн 85% хөлөө тайруулах мэс засал хийлгэдэг. ЧШӨ-ний үеийн ХХ үүсэхээс урьдчилан сэргийлэх, ХХ-ийн эрсдэлтэй өвчтөнүүдийг эрт илрүүлж зөв зохистой хянаж эмчилснээр хөл тайруулах мэс заслыг 49-85% хүртэл бууруулах боломжтой.3,5
Зорилго, зорилтууд: Хоёрдугаар хэлбэрийн чихрийн шижин өвчтэй хүмүүсийн хөлийн хүндрэлийн эрсдлийг судлах.
1. Хоёрдугаар хэлбэрийн ЧШ-тэй өвчтөнүүдэд ХХ-ийн эрсдэл бүхий өвчтөнүүдийг илрүүлж, ХХ үүсэхэд хүргэж байгаа эрсдэлт хүчин зүйлүүдийг тогтоох
2. Чихрийн шижин өвчний улмаас үүсэх ХХ-ийн эрсдэлтэй өвчтөнүүдийн эрсдлийн зэргийг үнэлэх
3. Хөлийн шархтай өвчтөнүүдийн шархны үе шат, хэлбэрийг тодорхойлох
Материал, аргазүй: Бид судалгаандаа Улаанбаатар хотын Клиникийн I, II нэгдсэн эмнэлэг, “Ачтан” Клиникийн эмнэлэг, Сүхбаатар, Баянгол, Баянзүрх, Чингэлтэй дүүргийн Эрүүл Мэндийн Төвүүдийн Дотоод шүүрлийн булчирхайн эмчийн хяналтанд байдаг 158 өвчтөнг санамсаргүй түүвэрлэлтийн аргаар сонгон авч, ДЭМБ-ийн халдварт бус өвчний хяналтын болон эрсдэлт хүчин зүйлсийн илрүүлэлт, ОУ-ын стандарт бүхий судалгааны аргачлалын дагуу дан нууцлалтайгаар, агшингийн судалгааны аргаар судалсан болно. Мэдээ, мэдээллүүдэд үндэслэн мэдээний сан үүсгэх, шалгах, боловсруулах, үр дүнг нэгтгэхдээ SPSS-15.0 статистикийн хэрэглээний программийг ашиглалаа.
ХХШ үүсэхэд нөлөөлөх хүчин зүйлсийг тодорхойлж гарсан үр дүнг харьцуулсан харьцаа (Odds ratio), 95%-ийн итгэх интервал (95% CI), P утгаар илэрхийлсэн.
Судалгаанд хамрагдагсдыг сонгон авах шалгуур
Судалгаанд оролцогсодыг ДЭМБ-аас гаргасан аргачлалын дагуу оношлогдсон:
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Care, 22, 7, 1029-35.
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13, 513-21.
8. Centers for Disease control and prevention: History of foot ul¬cer among persons with diabetes (2003). United States, 2000¬2003, MMWR Morb Mortal Wkly Rep, 52, 45, 1098-1102.
9. Fatma Al-Maskari and Mohammed El Sadig (2007). Preva¬lence of risk factors for diabetic foot complications. BMC Fam¬ily Practice,14, 245-251.
10. Rith Najarian SJ, Stolusky T, Gohdes DM (1997). Identifying diabetic patients at high risk for lower extremity amputation in a primary health care setting: A prospective evaluation of a simple screening criteria. Diabetes care,
15, 10,1386-1389.
- Diabetic foot complication
- peripheral vascular disease
- peripheral neuropathy
- foot ulcer
- foot amputation
- osteomielitis
- gangrene.
