Behavior in Self-care of the Foot and Foot Ulcers in Thai Non-insulin Dependent Diabetes Mellitus
SUTIN SRIUSSADAPORN, M.D.*, WANNEE NITIYANANT, M.D.*, SIRIRA T PLOYBUTR, M.Sc. *, SATHIT V ANNASAENG, M.D.*, APICHATI VICHAYANRAT, M.D.*
Affiliation : * Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Siriraj Hospital. Mahidol University, Bangkok 10700, Thailand.
Abstract A cross sectional study was conducted to examine behavior in self-care of the foot and foot ulcers in Thai non-insulin dependent diabetic patients. Fifty-five patients with foot ulcers (ulcer group; 42 females and 13 males) and 110 patients without foot ulcers (control group; 83 females and 27 males) were evaluated for self foot-care behavior using a questionnaire consisting of questions about foot inspection, foot cleaning, nail-care, and the use of footwear which possessed a total score of 20. The results showed that a mean total self foot-care score of the ulcer group was significantly lower than that of the control group (14.50 ± 3.35 vs 15.74 ± 2.31; p < 0.01). The patients with foot ulcers had lower mean scores in all of the four self foot-care categories than did those without foot ulcers. However, only the difference in foot cleaning score was statistically significant (7.35 ± 0.21 vs 7.88 ± 0.11; p < 0.05). A univariate analysis has shown that the risk of developing foot ulcers was significantly associated with a total self foot-care score of less than 15 with an odd ratio of 2.6 and a 95 per cent confidence interval of 1.3 - 5.6. Regarding the behavior in self foot ulcer-care, 45.5 per cent of the diabetic patients with foot ulcers had neglected them and 54.5 per cent had inappropriately cared for their ulcers. In conclusion, Thai non-insulin dependent diabetic patients with foot ulcers understood less about self foot-care practice than did those without foot ulcers. Incorrect self foot-care behavior particularly foot cleaning is associated with an increased risk of foot ulceration. In addition, diabetic patients should be advised about the correct self-care of their feet and foot ulcers in order to prevent foot ulceration and its compli- cations.
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