Dissertation
To receive a master's degree in nursing education
(internal surgical orientation)
Abstract
Introduction: Foot ulcers are the most common, serious and costly complications of diabetes and the risk of death in diabetic patients. Increases 2-4 times. Also, diabetic foot is one of the main causes of disability in patients with diabetes mellitus and is also considered as one of the chronic and preventable complications of this disease.
Aim: This study was conducted in order to determine the condition of foot patients with diabetes referred to the Razi Medical Education Center in Rasht in 2013.
Methodology: In a descriptive-analytical study, the condition of the foot 355 patients with diabetes referring to Razi Medical Education Center in Rasht city were examined in 2012. Data was collected through interviews and completing questionnaires. The questionnaire included: individual characteristics, disease characteristics, foot skin condition, foot structural abnormalities, sensory-motor neuropathy, foot pulses, and diabetic foot. In order to analyze the data, SPSS version 16 statistical software and descriptive and inferential statistical tests of Kia square and logistic regression were used.
Results: 1.16% of the examined patients had foot ulcers. According to the Kaya square test, between foot ulcer and dry skin without sweating (P=0.01), Fisher (P=0.004), toenail growth disorder (P=0.02), blister (P=0.008), hammertoe (P=0.05), fork toe (P=0.001), scoliosis (P=0.02), pincer surface pain and vibration sensation with diapason (P=0.001), right and left hind leg pulse and posterior tibia (P<0.001), previous wound site (P=0.001), reason for hospitalization and history of previous hospitalization due to leg problems and lesions (P=0.001) have a significant relationship. The final analysis of the variables based on the logistic regression model showed that the variables related to the condition of the feet of diabetic patients, blisters, calluses, and the cause of hospitalization are related to diabetes.
Conclusion: Since factors such as blisters, calluses, and hospitalization related to diabetes are influential in the occurrence of foot ulcers, nurses can play an effective role in the prevention and timely treatment of foot ulcers by identifying these risk factors. have.
Key words: diabetic foot - diabetes mellitus - foot ulcer
Statement of the problem
Diabetes is one of the chronic and very important diseases and a major health problem that is spreading all over the world (1). According to the definition of the American Diabetes Association, diabetes mellitus is a group of metabolic diseases whose common feature is an increase in blood sugar levels due to defects in insulin secretion, or defects in their function, or both (2, 3). In 2010, about 285 million people worldwide had diabetes (4) and it is expected to reach 366 million people in 2030 (5). According to the report of the World Health Organization, the number of people with diabetes in 2000 was 171 million (6). According to the statistics of the Iranian Diabetes Association in 2015, more than 4 million people in Iran were suffering from diabetes, and this number triples every 15 years(7). Also, according to the statistics of this association, there are 30 thousand diabetic patients in Gilan province (8).
More than 5 million people in the United States are at risk of problems and complications related to diabetes(9). Complications of diabetes are divided into two categories: macrovascular and microvascular. Microvascular complications include retinopathy and nerve damage, neuropathy, diabetic foot ulcer, and nephropathy. Macrovascular complications include cardiovascular complications such as myocardial involvement, atherosclerosis, increased blood pressure, and hyperlipidemia (10).
Diseases of the lower limbs, including peripheral artery disease, peripheral neuropathy, leg ulcers, and amputation of the lower limbs, are more common in diabetics than in non-diabetics and affect 30% of people over 40 years of age. puts (11). It is thought that foot problems related to diabetes have become more common in developed countries today (12).. According to the definition of the World Health Organization [1], diabetic foot is an infection, wound, or deep soft tissue destruction that occurs in connection with neurological abnormalities and different degrees of peripheral vascular abnormalities in the lower limbs (4, 13, 14). It is estimated that 1 to 4% of patients with type 2 diabetes develop a foot ulcer every year (15). Also, 15% of diabetics have a chronic ulcer on their feet or knees (9). According to the study of Fujiwara and his colleagues [2], the incidence of diabetic foot ulcers varied from 1% to 4% and its prevalence from 5.3% to 10.5% (4). Among 6000 patients with diabetes who were studied in England, 2% had active ulcers in their feet (16) and based on a study titled Diabetic Foot Care Education in Developing Countries, the prevalence of foot ulcers among 1477 patients was 5.9%, and these ulcers were associated with neuropathy. In general, in developing countries, 1 out of every 6 diabetics will experience an ulcer in their lifetime (12). Also, in a study by Alavi and his colleagues in Iran, the prevalence of foot ulcers among patients with diabetes was reported as 4% (17).
Several risk factors are effective in causing diabetic foot. Active wound, history of previous wound, amputation of lower limbs, presence of neuropathy problems, callus [3], edema, blister, cracked sole [4] and dry skin increase the risk of wound, infection or other amputations (18, 19). Based on the results of studies conducted in this regard, the prevalence of callus is 43.7%, fissure 26.5%, edema 1.8%, dry skin 10% and blister 1.3% have been reported (19, 20). In Shera's study [5], which was conducted under the title of the prevalence of chronic complications and risk factors in type 2 diabetic patients, the underlying cause of foot ulcers in 14% of the studied diabetic patients was the presence of blisters in the feet (20). Also, a study titled Investigation and Treatment of Diabetic Foot Ulcers has shown that peripheral neuropathy, deformity and trauma are among the risk factors for developing foot ulcers in 65% of people with diabetes (21). Peripheral neuropathy plays a major role in the development of diabetic foot ulcers and increases the probability of developing these ulcers approximately 8-18 times(19, 22) and annually, the incidence of foot ulcers increases by 4.5% in the presence of neuropathy and 13.8% in the presence of peripheral vascular disease(23). Neuropathy has been confirmed (21). Glycosylated hemoglobin control, which shows the average level of blood glucose in the last 3 months, is an important part of controlling neuropathic wounds, which reduces the complications of small vessels and amputation (9, 11); Because an increase in blood glucose levels can disrupt blood supply to the skin. When skin damage occurs, the body needs 50 times more blood supply to heal it. Following the increase in blood glucose level, the blood flow is disturbed, the blood flow required for recovery is not available; Therefore, skin damage worsens and progresses to ulceration and increases the risk of rapid onset of infection (9).
People with diabetes experience damage to small blood vessels, peripheral nerves, and deformities caused by motor nerve disorders, in proportion to the increase in blood glucose levels. In a study conducted among 1000 patients with diabetes, 7.5% had ischemia in the lower limbs (19).
Deformity of prominent bones such as the joints between fingers, toes, and heels may be rubbed by shoes and put under pressure, in which case skin injuries are caused through mechanical pressures (9). According to a study in this regard, the rate of foot deformity is 72.9%, the rate of abnormal leg bone protrusion is 11.4%, and joint movement limitation is 73% (22). In addition to the mentioned cases, in diabetic people due to factors such as poor eyesight, limitation of joint movements, inappropriate foot covering and inappropriate shoes, the cause of ulceration is provided (6).
Abstract
Introduction: Foot ulcers are the common, serious and costly complications of diabetes and increase the risk of death in diabetic patients 2-4 times. The diabetic foot is one of the major causes of disability in patients with diabetes mellitus and also considered as one of the chronic and preventable complications in these patients.