Risk factors associated to hospitalization in diabetic patients with foot ulcers

BACKGROUND: To analyse the risk factors associated with admissions of diabetic patients with foot ulcers, in order to prevent hospitalization. In-patient care supposes the greatest cost of the diabetic foot care. SUBJECTS AND METHOD: We studied 108 diabetic patients (male n = 59, mean age 68 [11] years, 100 type 2 diabetics, disease duration 16.4 [10.3]) who attended the diabetic foot unit between January 1996 and September 1997. Clinical and biochemical risk parameters were recor-. ded in a clinical protocol. Patients were followed up for a mean period of 200.2 (121.3) days. Admission was needed for 30 diabetic patients (28%). RESULTS: Risk factors for hospitalization were: higher ulcer diameter (1.9 [1.6] vs 3.4 [2.3] cm, p < 0.05), higher ulceration grade according to Wagner's classification (p = 0.005), presence of > 2 cm cellulitis (p < 0.001), worse metabolic control (HbA1c 7.6 [1.3] vs 8.6 [1.1], p < 0.05), and greater degree of retinopathy (p <less than> 0.005). Odds ratios (OR) for admission were: advanced diabetic retinopathy: OR 1.9 (CI 95% 1.3-2.9; p = 0.02); presence of moderate to severe polyneuropathy: OR 1.6 (Cl 95% 1.3-2.1; p = 0.05); upper HbA1c tertile: OR 2.4 (Cl 95% 1.2-4.2; p = 0.004). In the logistic regression model, both foot ulcer diameter and advanced diabetic retinopathy were significantly independent. CONCLUSIONS: In diabetic subjects with foot ulcers, hospitalization is independently related to the diameter of the ulcer and the degree of diabetic retinopathy. Therapeutic and preventive approaches should be strengthened in this subgroup of diabetic patients to prevent their hospitalization.