Clinical Characteristics of Diabetic Patients with Initial and Recurrent Foot Ulcers

  Objective  To explore the risk factors for the recurrence of foot ulcers by analyzing clinical characteristics of the patients with diabetic foot ulcers (DFU) in West China Hospital, Sichuan University.

  Methods  A retrospective analysis was carried out with the clinical data of 817 DFU patients hospitalized at West China Hospital, Sichuan University between January 1, 2012 and December 31, 2020. The patients were divided into an initial ulceration group (502 cases) and a recurrent ulceration group (315 cases) according to their history of foot ulcers. The differences in clinical characteristics between the two groups were compared, and multivariate logistic regression analysis was conducted to identify the risk factors associated with the recurrence of foot ulcers.

  Results  Initial and recurrent DFU patients both had predominantly neuro-ischemic foot ulcers, and the most common sites of ulceration were the first and fifth toes in both groups. Compared with the initial DFU group, more patients in the recurrent group had foot ulcers of Wagner grade 3 and ulcerous wounds located on calluses (P<0.05), and fewer patients in the recurrent group suffered from foot gangrene (P<0.05). Patients with recurrent DFU had lower glycated hemoglobin, platelet counts, and fibrinogen levels (P<0.05), and higher serum uric acid and creatinine levels (P<0.05). Hemoglobin, white blood cell count, estimated glomerular filtration rate, erythrocyte sedimentation rate and C-reactive protein levels were not significantly different between the two groups (P>0.05). Multivariable logistic regression analysis showed that male sex (OR=1.555, 95% CI: 1.097-2.204, P=0.013), duration of diabetes≥10 years (OR=2.369, 95% CI: 1.473-3.810, P<0.001), history of amputation (OR=4.518, 95% CI: 2.386-8.553, P<0.001), foot osteoporosis (OR=1.711, 95% CI: 1.065 to 2.751, P=0.027), ulcerous wound located on foot callus (OR=1.786, 95% CI: 1.058-3.012, P=0.030), and coronary heart disease (OR=0.668, 95% CI:0.453-0.987, P=0.043) were significantly associated with the recurrence of foot ulcers.

  Conclusions  Male sex, duration of diabetes being over 10 years, history of previous amputation, foot osteoporosis, and ulcerous wounds located on foot callus are independent risk factors of recurrent foot ulcers in patients with DFU. Therefore, even after their foot ulcers have healed, special attention should be given to the care of foot for patients with DFU, which may reduce the recurrence of foot ulcers.