Factors associated with the risk of diabetic foot in patients with diabetes mellitus in Primary Care

Lira, Jefferson Abraão Caetano; Nogueira, Lídya Tolstenko; Oliveira, Bianca Maria Aguiar de; Soares, Débora dos Reis; Santos, Ana Maria Ribeiro dos; Araújo, Telma Maria Evangelista de

Acessibilidade / Reportar erro

Brasil

Revista da Escola de Enfermagem da USP

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/S1980-220X2020019503757 copy

Factors associated with the risk of diabetic foot in patients with diabetes mellitus in Primary Care ^* * Extracted from the dissertation “Avaliação do rastreamento e da monitorização de pessoas com pé diabético na Atenção Primária à Saúde”, Programa de Pós-Graduação em Enfermagem, Universidade Federal do Piauí, 2019.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To analyze factors associated with diabetic foot risk in patients with diabetes mellitus assisted in Primary Care.

Method

Observational, analytic, and transversal study took place in Teresina, Piauí, with diabetic patients who are assisted in Primary Care. Data collection took place through interviews, foot clinical exams, and medical record analysis. We used the Mann-Whitney, Pearson’s Chi-square and multiple logistic regression statistics tests to analyze the data. The association power among categorical variables was measured by Odds Ratio .

Results

322 patients participated. Marital status with a partner presented a protection factor (p = 0.007). Risk factors for the development of the diabetic foot are: arterial hypertension (p = 0.045), obesity (p = 0.011), smoking (p = 0.027), not being submitted to follow ups (p = 0.046), inadequate control of capillary blood glucose (p < 0.001), indisposition to the care of the foot (p=0.014), and foot self-exam less frequently (p = 0.040).

Conclusion

Sociodemographic, clinical, and self-care aspects interfere in diabetic foot development, highlighting the necessity of effective follow up tracking and educational interventions for patients with diabetes mellitus in Primary Care.

Diabetes Mellitus; Diabetic Foot; Mass Screening; Primary Health Care; Nursing

Variables	Median	Minimum	Maximum	p value
Age in years	62.0	26.0	87.0	0.046
Years of study	7.5	0.0	18.0	0.008
Income in reais	998.0	0.0	5998.0	0.429
DM diagnosis time in years	6.5	0.0	63.0	< 0.001
BMI	27.9	19.1	46.4	0.195
Number of foot complications	2.0	0.0	8.0	< 0.001

Variables	Risk of diabetic foot		OR raw	IC 95%	p value
	Yes	No
	n (%)	n (%)
Marital status
With a partner*	148 (73.6)	53 (26.4)	0.70	0.51 – 0.98	0.046
No partner	76 (62.8)	45 (37.2)
Diabetes type
Diabetes type 1*	14 (77.8)	4 (22.2)	1.57	0.50 – 4.89	0.436
Diabetes type 2	210 (69.1)	94 (30.9)
Arterial hypertension
Yes*	171 (73.7)	61 (26.3)	1.96	1.17 – 3.26	0.010
No	53 (58,9)	37 (41.1)
Obesity
Yes*	69 (78.4)	19 (21.6)	1.85	1.04 – 3.29	0.034
No	155 (66.2)	79 (33.8)
Smoking
Yes*	28 (84.8)	5 (15.2)	2.66	0.99 – 7.10	0.044
No	196 (67.8)	93 (32.2)
Alcohol use
Yes*	38 (67.9)	18 (32.1)	0.91	0.49 – 1.69	0.760
No	186 (69.9)	80 (30.1)
Follow ups
Yes*	25 (56.8)	19 (43.2)	0.57	0.33 – 0.99	0.048
No	199 (71.6)	79 (28.4)
Monitoring
Yes*	92 (67.6)	44 (32.4)	0.86	0.53 – 1.38	0.522
No	132 (71.0)	54 (29.0)

Variables	Risk of diabetic foot		RawOR	IC 95%	p value
	Yes	No
	n (%)	n (%)
Patient searches for professional health care whenever she/he has a problem with her/his foot
No*	123 (72.8)	46 (27.2)	1.38	0.86 – 2.22	0.187
Yes	101 (66.0)	52 (34)
Patient has someone who encourages or helps her/him in the care of the foot
No*	130 (69.9)	56 (30.1)	1.04	0.64 – 1.68	0.881
Yes	94 (69.1)	42 (30.9)
Patient practices physical activity for at least 30 minutes/day
Not once*	133 (72.7)	50 (27.3)	1.4	0.87 – 2.26	0.164
At least once a week	91 (65.5)	48 (34.5)
Patient controls the capillary blood glucose levels
No*	154 (80.2)	38 (19.8)	3.47	2.11 – 5.70	< 0.001
Yes	70 (53.8)	60 (46.2)
Patient takes prescribed medications as recommended
No*	16 (76.2)	5 (23.8)	1.43	0.51 – 4.02	0.495
Yes	208 (69.1)	93 (30.9)
The health professional advises about the care of the foot
No*	159 (71.0)	65 (29.0)	1.24	0.75 – 2.07	0.403
Yes	65 (66.3)	33 (33.7)
Patient has disposition to take care of the foot
No*	68 (86.1)	11 (13.9)	3.45	1.73 – 6.87	< 0.001
Yes	156 (64.2)	87 (35.8)
Patient exams the foot frequently
No	122 (80.3)	30 (19.7)	_	_	< 0.001
Weekly	71 (64.0)	40 (36.0)
Daily	31 (52.5%)	28 (47.5)
Patient dries the gaps between her/his toes
No	100 (77.5)	29 (22.5)	_	_	0.016
Weekly	73 (68.2)	34 (31.8)
Daily or after each bath	73 (68.2)	34 (31.8)
Patient checks the shoes before wearing them
No	65 (79.3)	17 (20.7)	_	_	0.009
Rarely	73 (73.7)	26 (26.3)
Always	86 (61.0)	55 (39.0)
Patient cuts the toes’ nails in a square shape
Never*	117 (76.5)	36 (23.5)	1.88	1.16 – 3.07	0.010
Yes, although it is not possible to assume how frequently	107 (63.3)	62 (36.7)
Patient applies moisturizer in the foot
Never*	134 (77.0)	40 (23.0)	2.16	1.33 – 3.50	0.002
Every day or almost every day	90 (60.8)	58 (39.2)
Patient makes dressings at home with homemade solutions or with other products
Yes*	63 (82.9)	13 (17.1)	2.56	1.33 – 4.91	0.004
No	161 (65.4)	85 (34.6)

Variables	OR adjusted	IC 95%	p value*
Age in years	0.99	0,96 – 1.01	0.604
Years of study	1.04	0.97 – 1.11	0.201
Marital status
With a partner	0.47	0.27 – 0.81	0.007
Time of diagnosis in years	0.92	0.88 – 0.95	< 0.001
Arterial hypertension
Yes	1.83	1.01 – 3.32	0.045
Obesity
Yes	2.27	1.21 – 4.28	0.011
Smoking
Sim	3.18	1.14 – 8.86	0.027
Follow ups
No	2.10	1.01 – 4.39	0.046
Patient controls the capillary blood glucose levels
No	3.02	1.74 – 5.25	< 0.001
Patient has disposition to take care of the foot
No	2.90	1.24 – 6.79	0.014
Patient self-exams the foot frequently
No	2.11	1.03 – 4.32	0.040
Patient dries the gaps between the toes
No	1.03	0.48 – 2.19	0.928
Patient checks the shoes before wearing them
No	0.98	0.42 – 2.30	0.977
Patient cuts the toes nails in a square shape
Never	0.55	0.27 – 1.12	0.103
Patient applies moisturizer in the foot
Never	1.00	0.51-1.96	0.989
Patient makes dressings at home with homemade solutions or with other products
Yes	1.86	0.85 – 4.03	0.117
Number of foot complications	0.63	0.51 – 0.77	< 0.001

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Jefferson Abraão Caetano Lira 24 de janeiro Street, 561, Centro-Sul CEP 64001-230 – Teresina, PI, Brazil j.abraaolira@gmail.com