Risk factor analysis on the healing time and infection rate of diabetic foot ulcers in a referral wound care clinic

Objective: Objectives. To determine the prevalence and risk factors for diabetic foot infection (DFI), and to identify factors associated with delayed wound healing of diabetic foot ulcer (DFU). Method: The retrospective study was performed in a referral wound care clinic in Hospital Kuala Lumpur. Data was collected from January 2014 to October 2016 on DFU patients who attended this clinic. Results: Of the 340 patients (216 male and 124 female) DFU patients who attended the clinic (mean age: 58.1 +/- 10.8 years old), 41.5% presented with infection with a mean cross-sectional ulcer area of 21.5 +/- 33.2cm(2) . Binary logistic regression analysis revealed that patients of Chinese ethnicity (OR: 3.39; 95%CI 1.49 to 7.70), with fasting blood glucose >= 7mmol/l (OR: 3.41; 95%CI 1.57 to 7.39), ulcer size >= 10cm(2) (OR: 2.90; 95%CI 1.45 to 5.82) and blood pressure >= 140/90mmHg (OR: 2.52; 95%CI 1.54 to 4.14) were more likely to develop DFI. The median healing time for patients with DFUs was three months. There were six variables identified as significantly associated with prolonged healing time of DFU, namely presence of infection (p<0.001), poor glycaemic control with fasting blood glucose >= 7mmol/l (p<0.001), high blood pressure 140/90mmHg (p<0.001), large DFU size >= 2cm(2) (p<0.001), history of amputation (p<0.005) and plantar location of the DFU (p<0.05). Conclusion: Large DFU size, poor glycaemic and blood pressure control are common risk factors for both DFU and DFI. Unexpected high prevalence and ethnicity risk factor for DFI urge more comprehensive primary and secondary preventative strategies to reduce its incidence.