ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 GP124 | DOI: 10.1530/endoabs.63.GP124

Unrecognized high risk for diabetic foot ulcer among hospitalized patients

Shlomit Koren1, Moriah Sharabi2, Tamar Moriel Levy2, Daniel Fux3, Ronit Koren4 & Micha J Rapoport2

1Diabetes Unit, Assaf Harofeh Medical Center, Be’er Ya’akov, Israel; 2Internal medicine C, Assaf Harofeh Medical Center, Be’er Ya’akov, Israel; 3Internal medicine B, Assaf Harofeh Medical Center, Be’er Ya’akov, Israel; 4Internal medicine A, Assaf Harofeh Medical Center, Be’er Ya’akov, Israel.

Aim: Loss of protective sensation (LOPS) commonly precede Diabetic foot ulcer (DFU) which is one of the most fearsome/serious diabetic complications and the leading cause of foot amputation in T2D patients. However, the prevalence of this high risk state is unknown.

Methods: To estimate the presence of LOPS among hospitalized diabetes patients in internal wards, vibration perception and 10-g monofilament tests were done. Patients with foot ulcer or status post amputation were excluded.

Results: A total of 305 patients were tested. 165(54.1%) males and 140(45.9%) females. mean age was 70.3±12.2 years old. The mean duration of diabetes was 12 years (IQR 6–20). Mean HBA1C was 6.8 (IQR 6.15–7.98). 79(25.9%) patients had known retinopathy and 68(22.3%) had known nephropathy. 150(49.1%) had LOPS (either abnormal monofilament test or vibration test or both). Patients with LOPS tend to be older 72.1±11.8 vs 68.6±12.6 years old, P=0.005 (95% CI 0.53–0.657), had higher creatinine, 1.45±1.1 vs. 1.38±1.4, P=0.02 (95% CI 0.513–0.641), lower albumin, 35.3±5.1 vs. 36.9±4.7, P=0.014 (95% CI 0.518–0.647), lower hemoglobin, 11.5±2.3 vs 12.3±2.3, P=0.006 (95% CI 0.527–0.655) and compelling significant higher RDW, 16.2±2.1 vs 15.3±2.2, 0<0.001 (95% CI 0.583–0.708). Moreover, patients with LOPS tend to have abnormal feet pulses, P=0.001 (95% CI 0.552–0.706). No significant correlation was found between LOPS and disease duration, insulin-treatment, background-diseases or hospitalization cause.

Conclusions: Half of the diabetic patients in internal wards have unrecognized LOPS, the leading cause for DFU. Some simple clinical measures are correlated with LOPS. This window of opportunity should be used to recognize these patients and take measures for DFU prevention.

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