Clinical Grading of Diabetic Foot Ulcer Infection and its Predictors among Type 2 Diabetes Mellitus Patients: A Cross-sectional Study

Introduction: Globally, about 425 million people are living with diabetes mellitus. Diabetic Foot Ulcers (DFU) are one of the severe complications of poorly controlled diabetes and over the time, about 50% of DFUs become infected which may require hospitalization. Aim: To find out the DFU infection severity pattern and its predictors among T2DM patients. Materials and Methods: This cross-sectional study was conducted at Integrated Diabetes and Gestational Diabetes Clinic (IDGDC), IQ City Medical College and Multispecialty Hospital, Durgapur, West Bengal, India, among Type 2 Diabetes Mellitus (T2DM) patients from June 2018 to November 2018. Total 1534 T2DM patients attended IDGDC during data collection period of 4 months and 132 of them had diabetic foot ulcer. After taking written informed consent, detailed data were collected from 132 of study participants using pre-designed, semi structured and pre tested schedule developed with the help of Infectious Disease Society of America (IDSA) and International Working Group on the Diabetic Foot (IWGDF/ IDSA) classification system. Socio-demographic characteristic like age, sex, education, residence were recorded along with clinical data like glycated haemoglobin (HbA1c), duration of diabetes, treatment modalities Anthropometric measurements were taken as per World Health Organization (WHO) guidelines. T2DM was defined and classified as per American Diabetes Association (ADA) Guidelines. DFU infection severity was classified into uninfected, mild infection, moderate infection and severe infection as per IWGDF/IDSA guidelines. Chi-square test was used to show association between categorical variable. One-way Analysis of Variance (ANOVA) with Tukey's post-hoc test was used to show association between mean HbA1c level and DFU infection severity. The p-value <= 0.5 was considered significant. Results: Proportion of DFU was found to be 8.6%. As per the IWGDF/IDSA classification of DFU infection severity was found to be moderate in 59 (44.7%) of the study participants and mild in 32 (24.2%) of the study participants. 22 (16.7%) of study subjects had severe infection and required hospitalization for optimal care. Only 14.4% of study subjects did not have DFU infection. Increasing age (p-value=0.023), rural residence (p-value=0.015), poor education (p-value=0.001), obesity (p-value=0.001), central obesity (p-value=0.001), longer duration of diabetes (p-value=0.028), and poor glycemic control (p-value=0.001) was found to be significant risk factors for severe infection in DFU. Conclusion: Routine clinical assessment of DFU infection may help in making clinical decision of treatment modalities and help in saving lower limb as well as life of people with T2DM.