Diabetic foot in patients below 40 years of age

Data on diabetic foot ulcers (DFU) in young patients are scarce. We aimed to examine the risk factors, clinical presentation, wound characteristics, and outcome of DFU among young diabetic patients and to compare them with similar age diabetics without foot ulcer and those of older age diabetics with foot ulcers. A prospective cohort of 745 patients (834 ulcers) below 40 years of age, 7620 patients (9405 ulcers) ages 40 years and above, and 992 patients below 40 years diabetics without foot ulcers in a single multidisciplinary diabetes center were studied. Registered patients with foot ulcers in Jabir Abu Eliz Diabetes Centre (JADC) in Khartoum, Sudan from March 2001 to Dec 2011 were reviewed. Below 40 years of age constituted 8.9 % (n = 7450) of all patients with DFU. Male-to-female ratio was 1.7:1. IDDM type was prevalent in 60.9 %. Thirty-six per cent of below 40 years had peripheral neuropathy compared to 61.6 % of older group (p < 0.0002) and 8.7 % of below 40 without DFU (p < 0.0002). ABI < 0.9 was found in 38.7 % (n = 288) in below 40 years with ulcers compared to 41.4 % in older patients (p = 0.8989) and 36.3 % (n = 360) of below 40 without DFU (p = 0.3125). HbA1c > 7 % was significantly more in diabetics below 40 years with foot ulcers compared to those without foot ulcers (83.5 vs. 75.1 %) (p = 0.0002). In below 40 years of age, 80.1 % of ulcers healed compared to 70.6 % in older age group (p > 0.0002). Major lower extremity amputation was performed in 4.8 % in below 40 years patients compared to 7.3 % in older group (0.0105). Young diabetics with foot ulcers had significantly longer duration of the disease, more foot deformities, and callus formation and more severe neuropathy than young diabetics without ulcers but had a lesser duration of diabetes than elderly diabetics with foot ulcers. HbA1c in young diabetics with foot ulcers was significantly higher than young diabetics without ulcers, and their foot ulcers healed better and with less major lower extremity amputation than elderly patients.