Risk factors associated to hospitalization in diabetic patients with foot ulcers

BACKGROUND: To analyse the risk factors associated with admissions of diabe tic patients with foot ulcers, in order to prevent hospitalization. In-pati ent care supposes the greatest cost of the diabetic foot care. SUBJECTS AND METHOD: We studied 108 diabetic patients (male n = 59, mean ag e 68 [11] years, 100 type 2 diabetics, disease duration 16.4 [10.3]) who at tended the diabetic foot unit between January 1996 and September 1997. Clin ical and biochemical risk parameters were recor-. ded in a clinical protoco l. Patients were followed up for a mean period of 200.2 (121.3) days. Admis sion 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 Wagn er'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 grea ter degree of retinopathy (p <less than> 0.005). Odds ratios (OR) for admis sion 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 lo gistic regression model, both foot ulcer diameter and advanced diabetic ret inopathy were significantly independent. CONCLUSIONS: In diabetic subjects with foot ulcers, hospitalization is inde pendently related to the diameter of the ulcer and the degree of diabetic r etinopathy. Therapeutic and preventive approaches should be strengthened in this subgroup of diabetic patients to prevent their hospitalization.