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Factors Contributing to Diabetic Foot Ulcer among Patients with Type 2 Diabetes Mellitus
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Korean J Adult Nurs : Korean Journal of Adult Nursing

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Original Research

Factors Contributing to Diabetic Foot Ulcer among Patients with Type 2 Diabetes Mellitus

Seo Jin Park1, Taeyoung Yang2, Jun Young Lee3, Jinhee Kim1
Korean Journal of Adult Nursing 2018;30(1):106-114.
Published online: February 18, 2018

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Corresponding author: Kim, Jinhee https://orcid.org/0000-0002-8037-9174 Department of Nursing, College of Medicine, Chosun University, 309 Pilmun-daero, Dong-Gu, Gwangju 61452, Korea. Tel: +82-62-230-6410, Fax: +82-62-230-6329, E-mail: jinheeara@chosun.ac.kr
- This research was supported by research fund from Chosun University in 2015.
- This manuscript is a revision of the first author's mater's thesis from Chosun University.
• Received: November 15, 2017   • Accepted: February 18, 2018

© 2018 Korean Society of Adult Nursing

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to identify the factors contributing to diabetic foot ulcers (DFU) among patients with type 2 diabetes mellitus(DM).
  • Methods
    Data were collected from 131 patients who had been diagnosed with DM for more than six months. Patients recruited from three hospitals in Gwangju city were given both a foot examination to confirm the presence of a foot ulcer and an individual time of survey using questionnaires about foot care knowledge and self management behavior.
  • Results
    Factors contributing to DFU were male (adjusted odds ratio [aOR]=4.86, 95% confidence interval [CI]=1.16~20.44), history of DM-related hospitalization (aOR= 4.56, 95% CI=1.17~17.84), duration of DM (aOR=13.75, 95% CI=2.31~82.66 for those with time since diagnosis of 11~15 years; aOR=6.37, 95% CI=1.09~37.36 for those with time since diagnosis of 16-20 years; aOR=12.97, 95% CI=2.26~74.32 for those with time since diagnosis of over 21 years), DM diet (aOR=0.13, 95% CI=0.03-0.64 for those who did not practice dietary control), and exercise (aOR=15.59, 95% CI=3.49~69.64 for those who did not engage in regular exercise).
  • Conclusion
    The factors identified in this study provided strategic information for developing educational program targeting patients with DM to prevent DFC.
  • Key Words: Type 2 diabetes mellitus; Diabetic foot; Exercise
Table 1.
Diabetic Foot Ulcer according to Characteristics of Participants (N=131)
Variables Categories Total (n=131) With DFU (n=32) Without DFU (n=99) x2 or t p
n(%) n(%) n(%)
Gender Male 77(58.8) 27(84.4) 50(50.5) 11.45 ＜.001
Female 54(41.2) 5(15.6) 49(49.5)    
Age (year)   62.47±11.74 64.84±11.45 61.70±11.78 1.32 .188
≤59 53(40.5) (21.9)7 46(46.5) 8.28 .016
60~69 38(29.0) (46.9)15 23(23.2)    
≥70 40(30.5) 10(31.3) 30(30.3)    
Educational level (n=129) None 11(8.5) 5(15.6) 6(6.2) 3.74 .443
Elementary school 33(25.6) 9(28.1) 24(24.7)    
Junior high school 30(23.3) 5(15.6) 25(25.8)    
High school 29(22.5) 7(21.9) 22(22.7)    
≥ College 26(20.2) 6(18.8) 20(20.6)    
Marital status Married 98(74.8) 26(81.3) 72(72.7) 0.93 .334
Single 33(25.2) 6(18.8) 27(27.3)    
Smoking status Current smoker 21(16.0) 7(21.9) 14(14.1) 1.63 .442
Nonsmoker 73(55.7) 15(46.9) 58(58.6)    
Ex-smoker 37(28.2) 10(31.3) 27(27.3)    
History of hospitalization Yes 34(26.0) 20(62.5) 14(14.1) 29.43 ＜.001
No 97(74.0) 12(37.5) 85(85.9)    
Previous education for foot care (n=130) Yes 6(4.6) 3(9.4) 3(3.1) 2.18 .139
Never 124(95.4) 29(90.6) 95(96.9)    
BMI 　   23.96±3.38 23.65±2.50 24.06±3.62 0.71 .482
Underweight 3(2.3) (3.1)1 2(2.0) 3.11 .375
Normal 48(36.6) (34.4)11 37(37.4) 　 　
Overweight 35(26.7) (37.5)12 23(23.2)    
Obesity 45(34.4) 8(25.0) 37(37.4)    

DFU=diabetic foot ulcer; BMI=body mass index.

Table 2.
Diabetic Foot Ulcer according to Clinical Characteristics of Participants (N=131)
Variables Categories Total (n=131) With DFU (n=32) Without DFU (n=99) χ² or t p
n(%) n(%) n(%)
FPG (mg/dL) (n=113)   141.52±40.42 132.52±28.77 144.93±43.69 1.76 .083
＜110 7(6.2) 2(6.5) 5(6.1) 0.00 .945
≥110 106(93.8) 29(93.5) 77(93.9)    
Treatment with insulin Yes 26(19.8) 8(25.0) 18(18.2) 0.71 .401
No 105(80.2) 24(75.0) 81(81.8)    
Treatment with OHA Yes 125(95.4) 28(87.5) 97(98.0) 6.08 .014
No 6(4.6) 4(12.5) 2(2.0)    
Hypertension Yes 54(41.2) 16(50.0) 38(38.4) 1.35 .246
No 77(58.8) 16(50.0) 61(61.6)    
Retinopathy Yes 19(14.5) 0(0.0) 19(19.2) 7.18 .007
No 112(85.5) 32(100.0) 80(80.8)    
Nephropathy Yes 9(6.9) 1(3.1) 8(8.1) 0.93 .335
No 122(93.1) 31(96.9) 91(91.9)    
Foot deformity Yes 2(1.5) 1(3.1) 1(1.0) 0.72 .396
No 129(98.5) 31(96.9) 98(99.0)    
History of foot disease Yes 30(22.9) 10(31.3) 20(20.2) 1.67 .196
No 101(77.1) 22(68.8) 79(79.8)    
Duration of DM (year)   11.28±9.60 18.84±9.19 8.83±8.41 -5.72 ＜.001
≤10 78(59.5) (18.8)6 72(72.7) 31.65 ＜.001
11~15 15(11.5) (21.9)7 8(8.1)    
16~20 16(12.2) (18.8)6 10(10.1)    
≥21 22(16.8) 13(40.6) 9(9.1)    
DM diet Yes 29(22.1) 13(40.6) 16(16.2) 8.40 .004
No 102(77.9) 19(59.4) 83(83.8)    
Exercise 　 Yes 73(55.7) 9(28.1) 64(64.6) 13.07 ＜.001
No 58(44.3) 23(71.9) 35(35.4) 　 　

DFU=diabetic foot ulcer; DM=diabetes mellitus; FPG=fasting plasma glucose; OHA=oral hypoglycemic agents.

Table 3.
Foot-care Knowledge and Self-care Behavior (N=131)
Variables Total (n=131) With DFU (n=32) Without DFU (n=99) t p
M± SD M± SD M± SD
Knowledge 7.02±4.23 5.88±4.43 7.39±4.12 1.78 .077
Self-care behavior (n=124) 69.94±13.09 67.06±11.98 70.92±13.36 1.45 .151

DFU=diabetic foot ulcer.

Table 4.
Factors Contributing to Diabetic Foot Ulcer (N=131)
Variables Categories Unadjusted Adjusted∗
OR 95% CI p OR (95% CI) p
Gender Female 1 (Ref)     1 (Ref)    
Male 5.29 1.89~14.86 .002 4.86 1.16~20.44 .031
Age (year) ≤59 1 (Ref)     1 (Ref)    
60~69 4.29 1.53~11.97 .006 1.23 0.23~6.49 .812
≥70 2.19 0.75~6.39 .151 1.02 0.18~5.94 .980
History of hospitalization No 1 (Ref)     1 (Ref)    
Yes 10.12 4.07~25.19 ＜.001 4.56 1.17~17.84 .029
Treatment with OHA Yes 1 (Ref)     1 (Ref)    
No 6.93 1.21~39.80 .030 0.93 0.09~9.29 .951
Duration of DM (year) ≤10 1 (Ref)     1 (Ref)    
11~15 10.5 2.83~39.01 ＜.001 13.75 2.31~82.66 .004
16~20 7.2 1.94~26.70 .003 6.37 1.09~37.36 .040
≥21 17.33 5.27~56.97 ＜.001 12.97 2.26~74.32 .004
DM diet Yes 1 (Ref)     1 (Ref)    
No 0.28 0.12~0.68 .005 0.13 0.03~0.64 .012
Exercise Yes 1 (Ref)     1 (Ref)    
No 4.67 1.95~11.20 ＜.001 15.59 3.49~69.64 ＜.001

DFU=diabetic foot ulcer; OR=odds ratio; CI=confidence interval; Ref=reference; OHA=oral hypoglycemic agents; DM=diabetes mellitus.

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    • Daily Life Management Guidelines for Diabetic Foot Patients
      Ahyoung Kim
      The Journal of Korean Diabetes.2023; 24(4): 214.     CrossRef
    • Factors Related to the Occurrence and Number of Chronic Diabetic Complications in Patients with Type 2 Diabetes Mellitus: Utilizing The National Health Insurance Service-National Health Screening Cohort in Korea, 2002~2015
      Haejung Lee, Misoon Lee, Gaeun Park, Ah Reum Khang
      Journal of Korean Gerontological Nursing.2022; 24(1): 22.     CrossRef

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    Factors Contributing to Diabetic Foot Ulcer among Patients with Type 2 Diabetes Mellitus
    Korean J Adult Nurs. 2018;30(1):106-114.   Published online February 28, 2018
    DOI: https://doi.org/10.7475/kjan.2018.30.1.106
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    Factors Contributing to Diabetic Foot Ulcer among Patients with Type 2 Diabetes Mellitus
    Korean J Adult Nurs. 2018;30(1):106-114.   Published online February 28, 2018
    DOI: https://doi.org/10.7475/kjan.2018.30.1.106
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    Factors Contributing to Diabetic Foot Ulcer among Patients with Type 2 Diabetes Mellitus
    Factors Contributing to Diabetic Foot Ulcer among Patients with Type 2 Diabetes Mellitus

    Diabetic Foot Ulcer according to Characteristics of Participants (N=131)

    Variables Categories Total (n=131) With DFU (n=32) Without DFU (n=99) x2 or t p
    n(%) n(%) n(%)
    Gender Male 77(58.8) 27(84.4) 50(50.5) 11.45 ＜.001
    Female 54(41.2) 5(15.6) 49(49.5)    
    Age (year)   62.47±11.74 64.84±11.45 61.70±11.78 1.32 .188
    ≤59 53(40.5) (21.9)7 46(46.5) 8.28 .016
    60~69 38(29.0) (46.9)15 23(23.2)    
    ≥70 40(30.5) 10(31.3) 30(30.3)    
    Educational level (n=129) None 11(8.5) 5(15.6) 6(6.2) 3.74 .443
    Elementary school 33(25.6) 9(28.1) 24(24.7)    
    Junior high school 30(23.3) 5(15.6) 25(25.8)    
    High school 29(22.5) 7(21.9) 22(22.7)    
    ≥ College 26(20.2) 6(18.8) 20(20.6)    
    Marital status Married 98(74.8) 26(81.3) 72(72.7) 0.93 .334
    Single 33(25.2) 6(18.8) 27(27.3)    
    Smoking status Current smoker 21(16.0) 7(21.9) 14(14.1) 1.63 .442
    Nonsmoker 73(55.7) 15(46.9) 58(58.6)    
    Ex-smoker 37(28.2) 10(31.3) 27(27.3)    
    History of hospitalization Yes 34(26.0) 20(62.5) 14(14.1) 29.43 ＜.001
    No 97(74.0) 12(37.5) 85(85.9)    
    Previous education for foot care (n=130) Yes 6(4.6) 3(9.4) 3(3.1) 2.18 .139
    Never 124(95.4) 29(90.6) 95(96.9)    
    BMI 　   23.96±3.38 23.65±2.50 24.06±3.62 0.71 .482
    Underweight 3(2.3) (3.1)1 2(2.0) 3.11 .375
    Normal 48(36.6) (34.4)11 37(37.4) 　 　
    Overweight 35(26.7) (37.5)12 23(23.2)    
    Obesity 45(34.4) 8(25.0) 37(37.4)    

    DFU=diabetic foot ulcer; BMI=body mass index.

    Diabetic Foot Ulcer according to Clinical Characteristics of Participants (N=131)

    Variables Categories Total (n=131) With DFU (n=32) Without DFU (n=99) χ² or t p
    n(%) n(%) n(%)
    FPG (mg/dL) (n=113)   141.52±40.42 132.52±28.77 144.93±43.69 1.76 .083
    ＜110 7(6.2) 2(6.5) 5(6.1) 0.00 .945
    ≥110 106(93.8) 29(93.5) 77(93.9)    
    Treatment with insulin Yes 26(19.8) 8(25.0) 18(18.2) 0.71 .401
    No 105(80.2) 24(75.0) 81(81.8)    
    Treatment with OHA Yes 125(95.4) 28(87.5) 97(98.0) 6.08 .014
    No 6(4.6) 4(12.5) 2(2.0)    
    Hypertension Yes 54(41.2) 16(50.0) 38(38.4) 1.35 .246
    No 77(58.8) 16(50.0) 61(61.6)    
    Retinopathy Yes 19(14.5) 0(0.0) 19(19.2) 7.18 .007
    No 112(85.5) 32(100.0) 80(80.8)    
    Nephropathy Yes 9(6.9) 1(3.1) 8(8.1) 0.93 .335
    No 122(93.1) 31(96.9) 91(91.9)    
    Foot deformity Yes 2(1.5) 1(3.1) 1(1.0) 0.72 .396
    No 129(98.5) 31(96.9) 98(99.0)    
    History of foot disease Yes 30(22.9) 10(31.3) 20(20.2) 1.67 .196
    No 101(77.1) 22(68.8) 79(79.8)    
    Duration of DM (year)   11.28±9.60 18.84±9.19 8.83±8.41 -5.72 ＜.001
    ≤10 78(59.5) (18.8)6 72(72.7) 31.65 ＜.001
    11~15 15(11.5) (21.9)7 8(8.1)    
    16~20 16(12.2) (18.8)6 10(10.1)    
    ≥21 22(16.8) 13(40.6) 9(9.1)    
    DM diet Yes 29(22.1) 13(40.6) 16(16.2) 8.40 .004
    No 102(77.9) 19(59.4) 83(83.8)    
    Exercise 　 Yes 73(55.7) 9(28.1) 64(64.6) 13.07 ＜.001
    No 58(44.3) 23(71.9) 35(35.4) 　 　

    DFU=diabetic foot ulcer; DM=diabetes mellitus; FPG=fasting plasma glucose; OHA=oral hypoglycemic agents.

    Foot-care Knowledge and Self-care Behavior (N=131)

    Variables Total (n=131) With DFU (n=32) Without DFU (n=99) t p
    M± SD M± SD M± SD
    Knowledge 7.02±4.23 5.88±4.43 7.39±4.12 1.78 .077
    Self-care behavior (n=124) 69.94±13.09 67.06±11.98 70.92±13.36 1.45 .151

    DFU=diabetic foot ulcer.

    Factors Contributing to Diabetic Foot Ulcer (N=131)

    Variables Categories Unadjusted Adjusted∗
    OR 95% CI p OR (95% CI) p
    Gender Female 1 (Ref)     1 (Ref)    
    Male 5.29 1.89~14.86 .002 4.86 1.16~20.44 .031
    Age (year) ≤59 1 (Ref)     1 (Ref)    
    60~69 4.29 1.53~11.97 .006 1.23 0.23~6.49 .812
    ≥70 2.19 0.75~6.39 .151 1.02 0.18~5.94 .980
    History of hospitalization No 1 (Ref)     1 (Ref)    
    Yes 10.12 4.07~25.19 ＜.001 4.56 1.17~17.84 .029
    Treatment with OHA Yes 1 (Ref)     1 (Ref)    
    No 6.93 1.21~39.80 .030 0.93 0.09~9.29 .951
    Duration of DM (year) ≤10 1 (Ref)     1 (Ref)    
    11~15 10.5 2.83~39.01 ＜.001 13.75 2.31~82.66 .004
    16~20 7.2 1.94~26.70 .003 6.37 1.09~37.36 .040
    ≥21 17.33 5.27~56.97 ＜.001 12.97 2.26~74.32 .004
    DM diet Yes 1 (Ref)     1 (Ref)    
    No 0.28 0.12~0.68 .005 0.13 0.03~0.64 .012
    Exercise Yes 1 (Ref)     1 (Ref)    
    No 4.67 1.95~11.20 ＜.001 15.59 3.49~69.64 ＜.001

    DFU=diabetic foot ulcer; OR=odds ratio; CI=confidence interval; Ref=reference; OHA=oral hypoglycemic agents; DM=diabetes mellitus.
    Table 1. Diabetic Foot Ulcer according to Characteristics of Participants (N=131)

    DFU=diabetic foot ulcer; BMI=body mass index.

    Table 2. Diabetic Foot Ulcer according to Clinical Characteristics of Participants (N=131)

    DFU=diabetic foot ulcer; DM=diabetes mellitus; FPG=fasting plasma glucose; OHA=oral hypoglycemic agents.

    Table 3. Foot-care Knowledge and Self-care Behavior (N=131)

    DFU=diabetic foot ulcer.

    Table 4. Factors Contributing to Diabetic Foot Ulcer (N=131)

    DFU=diabetic foot ulcer; OR=odds ratio; CI=confidence interval; Ref=reference; OHA=oral hypoglycemic agents; DM=diabetes mellitus.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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