The Foot at Risk in Nigerians With Diabetes Mellitus-The Nigerian Scenario

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Diabetic foot ulceration is a major source of morbidity and mortality in patients with diabetes mellitus. Diabetics are 40 times more likely to suffer a lowerlimb amputation than those without the condition and as such the importance of this DM complication cannot be over-emphasized. This study sets out to describe and determine the prevalence of the “foot at risk” for ulceration in diabetic patients in an urban out patient clinic in Lagos, Nigeria. Subjects and Methods: This was a cross-sectional study carried out at the Diabetes Clinic of the Lagos University Teaching Hospital, Lagos, Nigeria for a period of one year (2001-2002). One thousand, one hundred and forty patients with diabetes mellitus (DM) were screened to obtain a number of 474 with the foot at risk for ulceration. The “foot at risk” in people with diabetes mellitus (DM) refers to the foot with intact skin which may have bony deformities or preulcerative lesions such as claw toes, hammer toes, hallux valgus, prominent metatarsal heads, callus formation, bunion, bunionnette, charcot/ bony prominences, dry skin, warm foot with prominent vessels, previous ulceration and or amputation, onychomycosis, features of neuropathy and vasculopathy. Data was analyzed using the Statistical package for the social sciences (SPSS) version 10. Results: The prevalence of DM patients with the foot at risk in this study (41.5%) was high. Of the 474 study subjects with the “foot at risk” for ulceration, 9(1.9%) had type 1 DM and 465 (98.1%) had type 2 DM. More than half of the patients were elderly (>61years) and either overweight or obese. The duration of diabetes and the mean fasting plasma glucose was higher in patients with type 1 DM but this difference was not statistically significant. In both types of diabetes, more than 50% of the subjects had poor glucose control. Conclusions: The 41.5% prevalence of the footat- risk for ulceration among Nigerian patients with diabetes mellitus is high. In a resource poor country like Nigeria, in order to prevent foot ulceration, preventive measures should be targeted mainly at the high risk group.