The Foot at Risk in Nigerians With Diabetes Mellitus-The Nigerian Scenario

D iabetic foot ulceration is a major sourceof morbidity and mortality in patientswith diabetes mellitus. Diabetics are 40times more likely to suffer a lowerlimbamputation than those without the conditionand as such the importance of this DMcomplication cannot be over-emphasized. Thisstudy sets out to describe and determine theprevalence of the foot at risk for ulceration indiabetic patients in an urban out patient clinic inLagos, Nigeria.Subjects and Methods: This was a cross-sectionalstudy carried out at the Diabetes Clinic of theLagos University Teaching Hospital, Lagos, Nigeriafor a period of one year (2001-2002). Onethousand, one hundred and forty patients withdiabetes mellitus (DM) were screened to obtain anumber of 474 with the foot at risk for ulceration.The foot at risk in people with diabetesmellitus (DM) refers to the foot with intact skinwhich may have bony deformities or preulcerativelesions such as claw toes, hammertoes, hallux valgus, prominent metatarsal heads,callus formation, bunion, bunionnette, charcot/bony prominences, dry skin, warm foot withprominent vessels, previous ulceration and oramputation, onychomycosis, features of neuropathyand vasculopathy. Data was analyzedusing the Statistical package for the social sciences(SPSS) version 10.Results: The prevalence of DM patients with thefoot at risk in this study (41.5%) was high. Of the474 study subjects with the foot at risk for ulceration,9(1.9%) had type 1 DM and 465 (98.1%)had type 2 DM. More than half of the patientswere elderly ( 61years) and either overweight orobese. The duration of diabetes .and the meanfasting plasma glucose was higher in patientswith type 1 DM but this difference was not statisticallysignificant. In both types of diabetes,more than 50% of the subjects had poor glucosecontrol.Conclusions: The 41.5% prevalence of the footat-risk for ulceration among Nigerian patientswith diabetes mellitus is high. In a resource poorcountry like Nigeria, in order to prevent foot ulceration,preventive measures should be targetedmainly at the high risk group.