Endocrine Abstracts

Diabetic foot syndrome (DFS) is currently considered the most severe of all late diabetes complications, resulting in deteriorating health outcomes, increased disability and reduced life expectancy.

Aim: To study the frequency of occurrence of DFS in rural peoples with diabetes in Uzbekistan.

Methods: Upon the international project WDF08-379 ‘Prevention of lower limb amputations in people with diabetes in Uzbekistan’, implemented by ‘Umid’ Charity Association jointly with Ministry of Health of Uzbekistan and RSSPCE in 2010–2012, 1262 patients were screened for DFS in 6 pilot rural regions, of them 184 peoples with Type 1 Diabetes and 1078 patients with Type 2 Diabetes, in the 25–65 age-group with duration of the disease 7–15 years. The examination of patients included determination of HbA1c and hyperglycemia level, Doppler ultrasound, ECG, the tests for vibration, pain, tactile and temperature sensitivity evaluation, as well as health examinations by multidisciplinary team (endocrinologist, surgeon, cardiologist, podiatrist).

Results: Findings from the screening showed the diabetic polyneuropathy in 83.2% of peoples with T2DM и 67.4% of those with T1DM, hyperkeratosis (64.8%), trophic ulcers (17.3%); ischemia of lower limbs vessels (24.2%), Charcot’s foot (9%); gangrene (0.3%). Frequency of DFS occurrence was 55.3% (T2DM) and 31.7% (T1DM) accordingly. The greatest number of lower limb amputations (3.8%) and re-amputations (2.0%) was found in T2DM patients with disease of more than 10 years. 68% of peoples with diabetes were hypertensive. The major cause for DFS developing and further amputation was prolonged decompensation stage (HbA1c> 8.6% in 94.2% of peoples with diabetes) and a poor knowledge on rules of foot care in rural regions.

Conclusions: Frequency of DFS occurrence in Uzbekistan was 55.3% (T2DM) and 31.7% (T1DM) accordingly. The greatest number of lower limb amputations (3.8%) and re-amputations (2.0%) was found in T2DM patients with 5–10 years disease duration. Decompensation stage (HbA1c > 9.5%) in 94.2% of peoples with diabetes is one of principal causes of high frequency of DFS occurrence, a considerable number of amputations and development of other diabetes complications. That shows the necessity to improve the education quality on foot care in Diabetes Self-Management schools.