Diabetic Foot ulcer Prevalence and Characteristics in Eastern Afghanistan

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Akmal Shams, Ikramullah Ibrahimi, Hayatullah Ahmadzai, Saifullah Hadi


Diabetes Mellitus is a very common metabolic disorder in our society causing both acute and chronic complications of which diabetic foot ulcer stays the leading etiology of amputations and disability. The main purpose of the study was to find out the prevalence and related characteristics of diabetic foot ulcer at the time of diagnosis or admission.

It was a cross sectional hospital based multicenter study including both male and female diabetic patients admitted to both internal medicine and orthopedic wards of Nangarhar university teaching hospital and Nangarhar regional hospital during six months period. 

The study included 310 diabetic patients of whom only 46 patients (14.8%) had foot ulcers. In fact, 20.4% of male and 11.9% of female diabetic patients suffered from ulcers. Diabetic foot ulcers were directly related with increasing age as it occurred 11.1% in the lowest age group compared to 25% in the age group ≥ 78 years. In addition, most ulcers were grade 2 and grad 3 (30.4% each) followed by grade 1 (26.1%) and the least, grade 4 (8.7%). 47.8% of ulcers had gray color while the remaining 52.2% ulcers had pink color. Moreover, 60.9% ulcers had sinuses and 26.1% of ulcers had bad smell. Ischemic changes on physical examination of the ipsilateral limb were evident in 91.3% of patients while neuropathic changes were evident in only 30.4% of patients. Ulcers were directly associated with the increasing duration of diabetes mellitus as half of the patients (50%) with diabetes duration of 21 years or greater had ulcer compared with 9.1% of 1-5 years of diabetes duration. 18/46 patients had history of amputation and 34.8% patients had hypertension as the comorbid factor.

Diabetic foot ulcer as a complication leading to disability was highly prevalent in our study more specifically in males, old age, type 1 diabetes and patient with long standing diabetes. Most ulcers respectively had ischemic, neuropathic and infectious or inflammatory changes. Awareness programs should be designed to both the patients and healthcare providers to decrease cases of diabetic foot ulcer and thus decrease disability and social burden.

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