Diabetic Foot Disease: the Association of Foot Deformities, Sensory Testing and Sugar Control in Type 2 Diabetic Patients in Kenyatta National Hospital

Abstract

Background: The 21st century has seen a rapid surge of diabetes in low and middle income countries. Sub-optimally controlled DM has been associated with a myriad of complications. Diabetic peripheral neuropathy(DPN) affects approximately 50% of Type II DM(T2DM) patients. DPN involves loss of protective sensation in the extremities, a primary risk factor to development of diabetic foot ulcers (DFU). DFU is considered the most likely forecaster of eventual limb loss/lower extremity amputation(LEA) in patients with type 2 diabetes. LEA associated disability causes decline in the quality of life. The World Health Organization (WHO) states up to 80% of the LEA can be averted with early detection and appropriate foot care. Measurement of vibration perception threshold(VPT) by Biothesiometer has emerged as a potent screening tool for sensation impairments with a high sensitivity (80%) and specificity (98%). Study objectives. This study evaluates foot deformities, sensory peripheral neuropathy and glycemic control amongst T2DM patients in Kenyatta National Hospital(KNH) Study design and site: Analytical cross-sectional study on known T2DM patients in KNH wards and outpatient clinics. Participants and Methods: The study highlighted the prevalence of foot deformities, assessed sensory neuropathy and correlated the same to glycemic control in T2DM patients with a broader goal to outline the risk of evolution of DFU in this cohort. Inclusion criteria: T2DM patients on hypoglycemic treatment. Patients with acute complications, concurrent use of drugs that affect glycemic metabolism/cause peripheral neuropathy were excluded. A clinical proforma including biodata, history and physical examination with comprehensive foot examination was administered. HbA1c levels was then analyzed. Michigan Neuropathy Screening Instrument (MNSI) was used to divide participants into those with.....................................................................