Factors associated with foot ulceration of people with diabetes mellitus living in rural areas

Silva, Juliana Marisa Teruel Silveira da; Haddad, Maria do Carmo Fernandez Lourenço; Rossaneis, Mariana Angela; Vannuchi, Marli Terezinha Oliveira; Marcon, Sonia Silva

doi:10.1590/1983-1447.2017.03.68767

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Original Article • Rev. Gaúcha Enferm. (Online) 38 (3) • 2017 • https://doi.org/10.1590/1983-1447.2017.03.68767 linkcopy

Factors associated with foot ulceration of people with diabetes mellitus living in rural areas

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective To analyze the factors associated with the risk of ulceration in the feet of people with diabetes mellitus living in rural areas.

Methods This is a cross-sectional study conducted with 293 individuals with diabetes mellitus, aged 40 years or older, living in the south of Brazil, in 2014. We analyzed socioeconomic variables, clinical conditions and foot self-care. We used the Poisson multiple regression model and the Prevalence Ratio (PR) and p-value<0.05 as a measure of association.

Results 43.7% of the sample presented risk of foot ulceration. The highest prevalence of foot ulceration risk was associated with people with lower purchasing power (PRadjusted=1.62/IC95%:1.52-2.22), with retinopathy (PRadjusted=1.30/IC95%:1.12-1.68) and alteration in foot moisture (PRadjusted=1.57/IC95%:1.22-2.01). We identified low education level (64.2%), high prevalence of arterial hypertension (86.3%) and onychomycosis in the feet (72%).

Conclusions Diabetic patients need an assessment of the risk of foot ulceration, especially those with longer diagnosis, chronic complications and low socio-educational level.

Diabetes mellitus; Rural population; Diabetic foot; Nursing; Self-care

Variables	N	Degree 0 (%)	Degree 1 (%)	Degree 2 (%)	Degree 3 (%)	Total (%)
Onychomycosis	210	43,0	10,2	14,3	4,4	71,9
Interdigital mycosis	82	15,0	5,5	4,8	2,7	28,0
Callosities	198	42,3	8,9	13,7	2,7	67,6
Feet moisture
Anhidrosis	104	17,1	5,8	9,9	2,7	35,5
Hyperhidrosis	09	1,8	0,3	0,3	0,7	3,1
Bromidrose	69	9,2	5,8	6,8	1,7	23,5
Loss of Protective Sensitivity	53	0,0	12,3	4,1	1,7	18,1
Decreased Pedicular Pulse	33	0,0	0,0	9,2	2,0	11,2
Lower Tibial Pulse Decreased	52	0,0	0,0	16,0	1,7	17,7
Changed Capillary Filler	08	0,0	0,4	1,4	1,0	2,8

Variables	Total		With foot ulcers risk		P	Gross RP	CI_95%

	N	%	N	%
Gender
Female	189	64,5	81	63,3	-	1	-
Male	104	35,5	47	36,7	0,689	1,05	0,50-1,37
Age
\|40 – 60	103	35,2	36	28,1	-	1	-
60 or more	190	64,8	92	71,9	0,034	1,38	1,02-1,87
Skin color
White	184	62,8	77	60,2	-	1	-
Not white	109	37,2	51	39,8	0,405	1,11	0,86-1,45
Marital Status
With partner	268	91,5	114	89,1	-	1	-
Without partner	25	8,5	14	10,9	0,150	1,31	0,90-1,91
Eduacation
1-8 years	188	64,2	91	71,1	0,037	1,37	1,01-1,85
8 years or more	105	35,8	37	28,9	-	1	-
Socioeconomic classification *
A/B	42	14,3	15	11,7	-	1	-
C	187	63,8	75	58,6	0,607	1,12	0,72-1,74
D/E	64	21,8	38	29,7	0,028	1,66	1,05-2,61

Variables	Total		With foot ulcers risk		P	Gross RP	CI_95%

	N	%	N	%
Diagnostic time
Up to 10 years	164	56,0	66	51,6	-	1	-
Above 10 years	129	44,0	62	48,4	0,179	1,19	0,92-1,54
Insulin-dependent
No	190	64,8	75	58,6	-	1	-
Yes	103	35,2	53	41,4	0,043	1,30	1,00-1,86
Obesity
No	138	47,1	66	51,6	-	1 -
Yes	155	52,9	62	48,4	0,178	0,83	0,64-1,08
Arterial hypertension
No	40	13,7	17	13,3	-	1 -
Yes	253	86,3	111	86,7	0,872	1,03	0,70-1,51
Retinopathy
No	206	70,3	81	63,3	-	1 -
Yes	87	29,7	47	36,7	0,016	1,37	1,06-1,77
Nephropathy
No	276	94,2	118	92,2	-	1	-
Yes	17	5,8	10	7,8	0,137	1,37	0,90-2,09
Stroke
No	274	93,5	116	90,6	-	1	-
Yes	19	6,5	12	9,4	0,034	1,49	1,03-2,16
Heart attack
No	268	91,5	113	88,3	-	1	-
Yes	25	8,5	15	11,7	0,048	1,42	1,00-2,01

Variables	Total		With foot ulcers risk		P	Gross RP	C_I95%

	N	%	N	%
Drought between the toes
Yes	176	60,1	76	59,4
No	117	39,9	52	40,6	0,831	1,02	0,79-1,34
Assesses the feet
Yes	189	64,5	85	66,4
No	104	35,5	43	33,6	0,553	0,91	0,69-1,21
Scalds the feet
No	188	64,2	87	68,0
Yes	105	35,8	41	32,0	0,242	0,84	0,63-1,12
Walks barefoot
No	224	76,5	104	81,3
Yes	69	23,5	24	18,8	0,108	0,74	0,52-1,06
Proper footwear
Yes	83	28,3	35	27,3
No	210	71,7	93	72,7	0,744	1,05	0,78-1,40
Proper nail clipping
Yes	175	59,7	77	60,2
No	118	40,3	51	39,8	0,895	0,98	0,75-1,28
Proper hygiene
Yes	202	68,9	83	64,8
No	91	31,1	45	35,2	0,171	1,20	0,92-1,56

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[TFN1001] Source: Research data, 2014.