The risk stratification of the diabetic foot and foot neuropathy in patients in the greater Durban area
Year 2023,
Volume: 4 Issue: 1, 7 - 19, 30.03.2023
Luke-atreyu Venketsamy
,
Zijing Hu
Abstract
With the rapid growth of diabetes, there are increased complications, particularly in patients' lower limbs. Diabetic foot ulcers affect 10-20% of the diabetic population. Early detection and management of risk factors can significantly reduce the development of diabetic foot ulcers and prevent foot amputation. A risk stratification tool can detect these risk factors and avoid amputation. This study aimed to identify and categorise diabetic patients into risk categories based on their diabetic foot status. The study was conducted in the greater Durban area in the KwaZulu-Natal province. The authors used a cross-sectional observational study design. The study population consisted of 155 diabetic patients. The Diabetes Foot Screening and Risk Stratification Form were used as data collection instruments. The study found that several patients who presented with diabetes were potential candidates for diabetic foot ulcers, and these patients needed immediate attention and care. Furthermore, it was identified that more males presented with diabetes and foot complications in the Durban area than females. From the results, it was concluded that diabetic patients should become conscious of foot care. Foot care education is recommended, and patients should be made aware of foot care, self-examination, and the need for medical attention.
Supporting Institution
University of Johannesburg
Project Number
REC-192-2019
Thanks
The authors would like to thank the University of Johannesburg for approving this study. The first author would also acknowledge appreciation to his supervisor Ms. M Purbhoo for guiding this study.
References
- Abdissa, D., Adugna, T., Gerema, U. Dereje, D. (2020). Prevalence of Diabetic Foot Ulcer and Associated Factors among Adult Diabetic Patients on Follow-Up Clinic at Jimma Medical Center, Southwest Ethiopia, 2019: An Institutional-Based Cross-Sectional Study. National library of medicine. DOI: 10.1155/2020/4106383. eCollection 2020.
- Akinbode, S. & Yewande, O. (2017). Nursing Interventions for the prevention of foot ulcers in adult diabetic inpatients. [Online] Available from https://www.semanticscholar.org/paper/Nursing-Interventions-for-the-prevention-of-foot-in-Akinbode-Yewande/7b6f8a78291d22aabcc06dfcc3903ab1b485f0ce
- Alexiadou, K. & Doupis, J. (2012). Management of Diabetic Foot Ulcers. Diabetes Therapy. [Online] 3(1). Available from: https://www.researchgate.net/publication/224821575_Management_of_Diabetic_Foot_Ulcers. [Accessed on 17th January 2021]
- Allen-Taylor, L., Margolis, D. J., Hoffstad, O. & Berlin, J. A. (2002). Diabetic neuropathic foot ulcers: the association of wound size, wound duration and wound grade on healing. National library of medicine, 25(10): 1835-1839. DOI: 10.2337/diacare.25.10.1835.
- American Diabetes Association. (2003) Peripheral Arterial Disease in People with Diabetes. [Online] Available from: https://care.diabetesjournals.org/content/diacare/26/12/3333.full.pdf. [Accessed 18th January 2021].
- American Endovascular & Amputation Prevention. (2020). What is Peripheral Arterial Disease and why does it affect so many patients with diabetes? [Online] Available from: https://americanendovascular.com/what-is-peripheral-arterial-disease/#:~:text=Peripheral%20Arterial%20Disease%20(PAD)%20is,are%20patients%20with%20diabetes%20mellitus. [Accessed 18th January 2021].
- Amin, N., Minuljo, T. T., Naibaho, R. M., Novitasari, D. & Pemayun, T. G. D. (2015). Risk factor for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case-control study. Diabetic Foot and Ankle. [Online] 6(1). Available from: https://www.tandfonline.com/doi/full/10.3402/dfa.v6.29629. [Accessed 17th January 2021].
- Arosi, I., Hiner, G. & Rajbhandar, S. (2016). Pathogenesis and treatment of callus in the diabetic foot. National library of medicine, 12(3): 179-183. DOI: 10.2174/1573399811666150609160219
- Atosona, A. & Larbie, C. (2019). Prevalence and Determinants of Diabetic Foot Ulcers and Lower Extremity Amputations in Three Selected Tertiary Hospitals in Ghana, Journal of Diabetes Research [Online] DOI: 10.1155/2019/7132861.
- Babitha, R. & Subathra, T. A. (2020). The Semmes-Weinstein monofilament examination is a single effective screening tool in diagnosing diabetic peripheral neuropathy when compared to the vibration perception threshold. National Journal of Physiology, Pharmacy and Pharmacology. [Online] Available from: http://www.njppp.com/fulltext/28-1584887631.pdf. [Accessed on 17th January 2021].
- Beaney, A.J., Nunney, I., Gooday, A.C. & Dhatariya, B.K. (2016). Factors determining the risk of diabetes foot amputations–A retrospective analysis of a tertiary diabetes foot care service. Journal of Diabetic Research and Clinical Practice, 114 (2016):69–74.
- Bogoshi, M., Distiler, L. A., Jacovides, A., Mahgoub, E. Y., Omar, M. K. A., Tarek, I. A. & Wajsbrot, D. B. (2014). An epidemiological study to assess the prevalence of diabetic peripheral neuropathic pain among adults with diabetes attending private and institutional outpatient clinics in South Africa. Journal of International Medical Research. [Online] Available from: https://www.researchgate.net/publication/262816157_An_epidemiological_study_to_assess_the_prevalence_of_diabetic_peripheral_neuropathic_pain_among_adults_with_diabetes_attending_private_and_institutional_outpatient_clinics_in_South_Africa. [Accessed 17th January 2021]
- Boulton, A. J. M. & Whitehouse, R. W. The Diabetic Foot. 2020 Mar 15. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, Dungan K, Grossman A, Hershman JM, Hofland J, Kalra S, Kaltsas G, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, McGee EA, McLachlan R, Morley JE, New M, Purnell J, Sahay R, Singer F, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 28121117.
- Burke, S. D., Sherr, D. & Lipman, R. D. (2014). Partnering with diabetes educators to improve patient outcomes. National library of medicine, 12(7): 45–53. DOI: 10.2147/DMSO.S40036
- Cardiovascular Diabetes Education. (n.d.) What is Type 2 diabetes and why does it occur? [Online] Available from: https://www.cdediabetes.co.za/home/diabetes/type-2-diabetes.html. [Accessed 17th January 2021]
- Carline, T. E., Khan, M. F. & Siddiqui, M. A. (2013). Gender Differences in living with diabetes mellitus. Journal of the Academy of medical sciences of Bosnia and Herzegovina, 25(2), 140–142. [Online] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769156/. [Accessed 20th January 2021]
- Cefalu, W. T., Heymsfield, S. B., Horswell, R., Hu, G., Johnson, J., Katzmarzyk, P. T., Ryan, D. H., Wang, Y. & Zhao, W. (2013). HbA1c and lower-extremity amputation risk in low-income patients with diabetes. Diabetes Care [Online] 36(11). Available from: https://care.diabetesjournals.org/content/36/11/3591. [Accessed on 17th January 2021]
- Centre for Diabetes and Endocrinology (2018). Clinical Guidelines. [Online] Available from: http://www.cdediabetes.co.za/uploads/images/files/CDE%20Clinical%20Guidelines_May%202018.pdf. [Accessed on 17th January 2021].
- Chou, S., Haraguchi, M., Imai, M., Komori, H., Takemura, H., Tsuichihara, S. & Watanabe, K. (2019). Screen system for Diabetes Peripheral Neuropathy using Foot Plantar Images on Different Hardness Floor. International Conference on Systems, Man and Cybernetics, Bari, 6 – 9 October 2019.
- Crawford, F., Inkster, M., Kleijnen, J. & Fahey, T. (2007). Predicting foot ulcers in patients with diabetes: a systematic review and meta-analysis. National Library of Medicine, 100(2): 65-86. DOI: 10.1093/qjmed/hcl140.
- Dinh, T. & Veves, A. (2008). The influence of gender as a risk factor in diabetic foot ulceration. Wounds. [Online] 20(5), 127-131. Available from: https://pubmed.ncbi.nlm.nih.gov/25942414/. [Accessed 20th January 2021].
- Fernandez-Torres, R., Ruiz-Munoz, M., Perez-Panero, A.J., Garcia-Romero, J.C. and Gonzalez-Sanchez, M. (2020). Clinician Assessment Tools for Patients with Diabetic Foot Disease: A Systematic Review. Journal of Clinical Medicine. 9(5): 1487. DOI: 10.3390/jcm9051487. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291260/ [Accessed on 31 March 2021].
- Foma, M. A., Jafali, J., Omoleke, S. A. & Saidu, Y. (2013). Awareness of diabetes mellitus among diabetic patients in the Gambia: a strong case for health education and promotion. BMC Public Health. [Online] 13. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3913398/. [Accessed on 17th January 2021].
- Forlee, M. (2010). What is the diabetic foot? Continuing Medical Education. [Online] 28(4), 152–156. Available from https://www.ajol.info/index.php/cme/article/view/71231/60190. [Accessed 18th January].
- Frowen, P., O’Donnell, M., Donald, L. & Burrow, G. (2012). Neal’s Disorders of The Foot, 8th ed. United Kingdom, Churchill Livingstone.
- Groenewald, A. J., Van de Merwe, L., Van Wyk, H. J., Van Zyl, S. & Walsh, C. (2014). Prevalence of diabetes mellitus in the rural southern Free State. Official journal of the South African Academy of Family Practice [Online] 51, 502-505. Available from: https://www.researchgate.net/publication/269354406_Prevalence_of_diabetes_mellitus_in_the_rural_southern_Free_State. [Accessed 17th January 2021].
- Gordon, P. & Bitton, A. (2013). Predict, Prioritize, Prevent. Nine things practices should know about risk precautions. Health2 Resources. Issue Brief, 2(2):1–7. Available from https://www.rmhpcommunity.org/sites/default/files/resource/Vol.%202%20Issue%202%20Predict,%20Prioritize,%20Prevent.pdf.
- Gurung, G., Pardhan, S., Parker, M., Raman, R., Sapkota, R. P. & Upadhyaya, T. (2018). Need to improve awareness and treatment compliance in high-risk patients for diabetic complications in Nepal. BMJ Open Diabetes Research & Care. [Online] 6(1). Available from: https://drc.bmj.com/content/6/1/e000525. [Accessed on 17th January 2021].
- Hawkins, B. M & Jaff, M. R. (2013). Epidemiology, risk factors and prognosis. In: Minar, K & Schillinger, M. (eds.) Peripheral vascular disease: basic and clinical perspectives. London, United Kingdom, Future Medicine Ltd, pp. 8–17.
- Hayashino, Y., Izumi, K., Nishimua, R., Okamura, S., Origasa, H. & Tajima, Naoko. (2016) Duration of diabetes and types of diabetes therapy in Japanese patients with Type 2 diabetes; The Japan Diabetes Complication and its Prevention prospective study 3. Journal of Diabetes Investigation. [Online] 8(2), 243-249. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5334313/. [Accessed on 20th January 2021]
- Huizen, J. (2019). The average age of onset for type 2 diabetes. [Online] Available from: https://www.medicalnewstoday.com/articles/317375 [Accessed on 17th January 2021].
- International Diabetes Federation. (2017). IDF Diabetes Atlas, 8th ed. Available from: https://diabetesatlas.org/upload/resources/previous/files/8/IDF_DA_8e-EN-final.pdf.
- Journal of Endocrinology, metabolism, and diabetes of South Africa. (2017). The 2017 SEMDSA Guidelines for the Management of Type 2 Diabetes, 22(1). Available from http://www.jemdsa.co.za/index.php/JEMDSA/article/view/647
- Levy, N. & Gillibrand, W. (2019). Management of diabetic foot ulcers in the community: an update, British Journal of Community Nursing, 24(3):1–14. DOI: 10.12968/bjcn.2019.24.
- Lu, Z. & Su, J. (2010). Clinical data management: Industry perspectives' current status, challenges, and future directions. Journal of clinical trials, 2010(2): 93-105. DOI: https://doi.org/10.2147/OAJCT.S8172
- Masic, I., Miokovic, M. & Muhamedagic, B. (2008). Evidence-based medicine-new approaches and challenges, 16(4): 219-225. DOI: 10.5455/aim.2008.16.219-225.
- McAra, S. (2011). Patient awareness of the loss of protective sensation in the diabetic foot: an opportunity for risk reduction? [Online] Available from: https://www.researchgate.net/publication/257882790_Patient_awareness_of_loss_of_protective_sensation_in_the_diabetic_foot_an_opportunity_for_risk_reduction. [Accessed 17th January 2021]
- Mbatha, M. (2017). Diabetes is the focus of the Durban Wellness Festival. SABCnewsonline. Available from http://www.sabcnews.com/sabcnews/durban-wellness-festival-increased-awareness-on-diabetes.
- Mehta, S. R., Kashyap, A. S. & Das, S. (2009). Diabetes mellitus in India: The modern scourge. National Library of Medicine, 65(1): 50-54. DOI: 10.1016/S0377-1237(09)80056-7
- Mokena, T. P., Mowa, C. N. & Subrina. (2017). Prevalence of Diabetic Foot Ulcers and Associated Risk Factors at Charlotte Maxeke Johannesburg Academic Hospital. MTech (Podiatry). [Unpublished]: University of Johannesburg. Retrieved from https://ujcontent.uj.ac.za/vital/access/services/Download/uj:30911/SOURCE1 .
- Monteiro-Soares, M., Vaz-Carneiro, A., Sampaio, S. & Dinis-Ribeiro, M. (2012). Validation and comparison of currently available stratification systems for patients with diabetes by the risk of foot ulcer development. European Journal of Endocrinology, 167: 401–407. Available from https://pubmed.ncbi.nlm.nih.gov/21249490/.
- Ntuli, S., Swart, A. & Lambert, C. V. (2018). Risk factors for diabetic foot ulceration. South African Journal of Diabetes and Vascular Diseases, 15(1): 32-36. Available from https://hdl.handle.net/10520/EJC-10055042ca
- Purbhoo, M. & Swart, A. (2015). Foot health-related quality of life of patients utilizing podiatric services at public health care facilities in Gauteng, South Africa. MTech. (Podiatry). [Unpublished]. The University of Johannesburg. Retrieved from https://ujcontent.uj.ac.za/vital/access/services/Download/uj:22554/SOURCE1
- Ramkisson, S., Pillay, B. & Sartorius, B. (2016). Psychosocial stress in South African patients with type 2 diabetes. Journal of Insulin Resistance 1(1). [Online] DOI: 10.4102/jir.v1i1.17
- Ramanathan, R. S. (2017). Correlation of duration, hypertension, and glycaemic control with microvascular complications of diabetes mellitus at a tertiary care hospital. Integral Mol Med 4. [Online] Available from https://www.oatext.com/Correlation-of-duration-hypertension-and-glycemic-control-with-microvascular-complications-of-diabetes-mellitus-at-a-tertiary-care-hospital.php#Article_Info. [Accessed 20th January 2021].
- Sahadew, N. & Singaram, V. S. (2019). Progress in diabetes care in the KwaZulu-Natal public healthcare sector: a decade of analysis. Journal of Endocrinology, Metabolism and Diabetes of South Africa, 24(3): 83-91. DOI: https://doi.org/10.1080/16089677.2019.1629080
- Shearman, C.P. (2015). Management of Diabetic Foot Complications, Springer-Verlag, London, 2015.
- Simmons, H. (2019). Diabetes in Men versus Women. [Online] Available from: https://www.news-medical.net/health/Diabetes-in-Men-versus-Women.aspx#:~:text=Diabetes%2C%20especially%20type%202%2C%20is,a%20greater%20risk%20of%20death.&text=Glucose%20is%20usually%20metabolised%20and,a%20pancreatic%20hormone%20called%20insulin. [Accessed 17th January 2021].
- Statista Research Department. (2020) Share of respondents with diabetes in India 2019 by age group. [Online] Available from: https://www.statista.com/statistics/1119414/india-share-of-respondents-with-diabetes-by-age-group/#:~:text=As%20per%20the%20results%20of,to%20have%20diabetes%20that%20year. [Accessed 17th January 2021].
- Tang, U. H., Zugner, R., Lisovskaja, V., Karlsson, J., Hagberg, K. & Tranberg, R. (2015). Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes are at high risk to develop foot ulcers. National Library of Medicine, 17(6), 257-293. DOI: 10.3402/dfa.v6.27593
- Tumbo, J. M. & Kadima, F. N. (2013). Screening of long-term complications and glycaemic control of patients with diabetes attending Rustenburg Provincial Hospital in North West Province, South Africa. African Journal of Primary Health Care & Family Medicine, 5(1) [Online] Available from https://phcfm.org/index.php/phcfm/article/view/375
- Thompson, A. T., Zipfel, B. & Aldous, C. (2021). The dysmorphic metatarsal parabola in diabetes - clinical examination and management: a narrative review. Journal of Endocrinology, Metabolism, and Diabetes of South Africa, 26(2), 40-45. DOI: https://doi.org/10.1080/16089677.2021.1897226
- Van Wyk, H. & Mostert, S. (2018). Poor diabetes management. South African Journal of Diabetes, 11(2), 16-21. [Online] Available from https://www.cdediabetes.co.za/uploads/cgblog/id27/SAJD_2_2018_No_ads.pdf
- Vascular centre. (2019) Diabetes Diabetic Foot. [Online] Available from: https://www.vascularcentre.co.za/diabetic-foot/. [Accessed 19th January 2021].
- Vileikyte, L. (2001). Diabetic foot ulcers: A quality of life issue. Diabetes/Metabolism Research and Reviews, 17(4), 246-249. https://www.researchgate.net/publication/11801169_Diabetic_foot_ulcers_A_quality_of_life_issue. [Accessed 31 March 2021}
- Vinik A., Casellini C. & Nevoret M. L. (2018). Diabetic Neuropathies. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279175/.
- World Health Organisation (WHO). (2019) Diabetes. Available from https://www.who.int/news-room/fact-sheets/detail/diabetes. [Accessed on 19 September 2019].
Yates, B. (2012). Merriman’s Assessment of the Lower Limb. 3rd ed. Churchill Livingstone. Elsevier Inc.
Year 2023,
Volume: 4 Issue: 1, 7 - 19, 30.03.2023
Luke-atreyu Venketsamy
,
Zijing Hu
Project Number
REC-192-2019
References
- Abdissa, D., Adugna, T., Gerema, U. Dereje, D. (2020). Prevalence of Diabetic Foot Ulcer and Associated Factors among Adult Diabetic Patients on Follow-Up Clinic at Jimma Medical Center, Southwest Ethiopia, 2019: An Institutional-Based Cross-Sectional Study. National library of medicine. DOI: 10.1155/2020/4106383. eCollection 2020.
- Akinbode, S. & Yewande, O. (2017). Nursing Interventions for the prevention of foot ulcers in adult diabetic inpatients. [Online] Available from https://www.semanticscholar.org/paper/Nursing-Interventions-for-the-prevention-of-foot-in-Akinbode-Yewande/7b6f8a78291d22aabcc06dfcc3903ab1b485f0ce
- Alexiadou, K. & Doupis, J. (2012). Management of Diabetic Foot Ulcers. Diabetes Therapy. [Online] 3(1). Available from: https://www.researchgate.net/publication/224821575_Management_of_Diabetic_Foot_Ulcers. [Accessed on 17th January 2021]
- Allen-Taylor, L., Margolis, D. J., Hoffstad, O. & Berlin, J. A. (2002). Diabetic neuropathic foot ulcers: the association of wound size, wound duration and wound grade on healing. National library of medicine, 25(10): 1835-1839. DOI: 10.2337/diacare.25.10.1835.
- American Diabetes Association. (2003) Peripheral Arterial Disease in People with Diabetes. [Online] Available from: https://care.diabetesjournals.org/content/diacare/26/12/3333.full.pdf. [Accessed 18th January 2021].
- American Endovascular & Amputation Prevention. (2020). What is Peripheral Arterial Disease and why does it affect so many patients with diabetes? [Online] Available from: https://americanendovascular.com/what-is-peripheral-arterial-disease/#:~:text=Peripheral%20Arterial%20Disease%20(PAD)%20is,are%20patients%20with%20diabetes%20mellitus. [Accessed 18th January 2021].
- Amin, N., Minuljo, T. T., Naibaho, R. M., Novitasari, D. & Pemayun, T. G. D. (2015). Risk factor for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case-control study. Diabetic Foot and Ankle. [Online] 6(1). Available from: https://www.tandfonline.com/doi/full/10.3402/dfa.v6.29629. [Accessed 17th January 2021].
- Arosi, I., Hiner, G. & Rajbhandar, S. (2016). Pathogenesis and treatment of callus in the diabetic foot. National library of medicine, 12(3): 179-183. DOI: 10.2174/1573399811666150609160219
- Atosona, A. & Larbie, C. (2019). Prevalence and Determinants of Diabetic Foot Ulcers and Lower Extremity Amputations in Three Selected Tertiary Hospitals in Ghana, Journal of Diabetes Research [Online] DOI: 10.1155/2019/7132861.
- Babitha, R. & Subathra, T. A. (2020). The Semmes-Weinstein monofilament examination is a single effective screening tool in diagnosing diabetic peripheral neuropathy when compared to the vibration perception threshold. National Journal of Physiology, Pharmacy and Pharmacology. [Online] Available from: http://www.njppp.com/fulltext/28-1584887631.pdf. [Accessed on 17th January 2021].
- Beaney, A.J., Nunney, I., Gooday, A.C. & Dhatariya, B.K. (2016). Factors determining the risk of diabetes foot amputations–A retrospective analysis of a tertiary diabetes foot care service. Journal of Diabetic Research and Clinical Practice, 114 (2016):69–74.
- Bogoshi, M., Distiler, L. A., Jacovides, A., Mahgoub, E. Y., Omar, M. K. A., Tarek, I. A. & Wajsbrot, D. B. (2014). An epidemiological study to assess the prevalence of diabetic peripheral neuropathic pain among adults with diabetes attending private and institutional outpatient clinics in South Africa. Journal of International Medical Research. [Online] Available from: https://www.researchgate.net/publication/262816157_An_epidemiological_study_to_assess_the_prevalence_of_diabetic_peripheral_neuropathic_pain_among_adults_with_diabetes_attending_private_and_institutional_outpatient_clinics_in_South_Africa. [Accessed 17th January 2021]
- Boulton, A. J. M. & Whitehouse, R. W. The Diabetic Foot. 2020 Mar 15. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, Dungan K, Grossman A, Hershman JM, Hofland J, Kalra S, Kaltsas G, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, McGee EA, McLachlan R, Morley JE, New M, Purnell J, Sahay R, Singer F, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 28121117.
- Burke, S. D., Sherr, D. & Lipman, R. D. (2014). Partnering with diabetes educators to improve patient outcomes. National library of medicine, 12(7): 45–53. DOI: 10.2147/DMSO.S40036
- Cardiovascular Diabetes Education. (n.d.) What is Type 2 diabetes and why does it occur? [Online] Available from: https://www.cdediabetes.co.za/home/diabetes/type-2-diabetes.html. [Accessed 17th January 2021]
- Carline, T. E., Khan, M. F. & Siddiqui, M. A. (2013). Gender Differences in living with diabetes mellitus. Journal of the Academy of medical sciences of Bosnia and Herzegovina, 25(2), 140–142. [Online] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769156/. [Accessed 20th January 2021]
- Cefalu, W. T., Heymsfield, S. B., Horswell, R., Hu, G., Johnson, J., Katzmarzyk, P. T., Ryan, D. H., Wang, Y. & Zhao, W. (2013). HbA1c and lower-extremity amputation risk in low-income patients with diabetes. Diabetes Care [Online] 36(11). Available from: https://care.diabetesjournals.org/content/36/11/3591. [Accessed on 17th January 2021]
- Centre for Diabetes and Endocrinology (2018). Clinical Guidelines. [Online] Available from: http://www.cdediabetes.co.za/uploads/images/files/CDE%20Clinical%20Guidelines_May%202018.pdf. [Accessed on 17th January 2021].
- Chou, S., Haraguchi, M., Imai, M., Komori, H., Takemura, H., Tsuichihara, S. & Watanabe, K. (2019). Screen system for Diabetes Peripheral Neuropathy using Foot Plantar Images on Different Hardness Floor. International Conference on Systems, Man and Cybernetics, Bari, 6 – 9 October 2019.
- Crawford, F., Inkster, M., Kleijnen, J. & Fahey, T. (2007). Predicting foot ulcers in patients with diabetes: a systematic review and meta-analysis. National Library of Medicine, 100(2): 65-86. DOI: 10.1093/qjmed/hcl140.
- Dinh, T. & Veves, A. (2008). The influence of gender as a risk factor in diabetic foot ulceration. Wounds. [Online] 20(5), 127-131. Available from: https://pubmed.ncbi.nlm.nih.gov/25942414/. [Accessed 20th January 2021].
- Fernandez-Torres, R., Ruiz-Munoz, M., Perez-Panero, A.J., Garcia-Romero, J.C. and Gonzalez-Sanchez, M. (2020). Clinician Assessment Tools for Patients with Diabetic Foot Disease: A Systematic Review. Journal of Clinical Medicine. 9(5): 1487. DOI: 10.3390/jcm9051487. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291260/ [Accessed on 31 March 2021].
- Foma, M. A., Jafali, J., Omoleke, S. A. & Saidu, Y. (2013). Awareness of diabetes mellitus among diabetic patients in the Gambia: a strong case for health education and promotion. BMC Public Health. [Online] 13. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3913398/. [Accessed on 17th January 2021].
- Forlee, M. (2010). What is the diabetic foot? Continuing Medical Education. [Online] 28(4), 152–156. Available from https://www.ajol.info/index.php/cme/article/view/71231/60190. [Accessed 18th January].
- Frowen, P., O’Donnell, M., Donald, L. & Burrow, G. (2012). Neal’s Disorders of The Foot, 8th ed. United Kingdom, Churchill Livingstone.
- Groenewald, A. J., Van de Merwe, L., Van Wyk, H. J., Van Zyl, S. & Walsh, C. (2014). Prevalence of diabetes mellitus in the rural southern Free State. Official journal of the South African Academy of Family Practice [Online] 51, 502-505. Available from: https://www.researchgate.net/publication/269354406_Prevalence_of_diabetes_mellitus_in_the_rural_southern_Free_State. [Accessed 17th January 2021].
- Gordon, P. & Bitton, A. (2013). Predict, Prioritize, Prevent. Nine things practices should know about risk precautions. Health2 Resources. Issue Brief, 2(2):1–7. Available from https://www.rmhpcommunity.org/sites/default/files/resource/Vol.%202%20Issue%202%20Predict,%20Prioritize,%20Prevent.pdf.
- Gurung, G., Pardhan, S., Parker, M., Raman, R., Sapkota, R. P. & Upadhyaya, T. (2018). Need to improve awareness and treatment compliance in high-risk patients for diabetic complications in Nepal. BMJ Open Diabetes Research & Care. [Online] 6(1). Available from: https://drc.bmj.com/content/6/1/e000525. [Accessed on 17th January 2021].
- Hawkins, B. M & Jaff, M. R. (2013). Epidemiology, risk factors and prognosis. In: Minar, K & Schillinger, M. (eds.) Peripheral vascular disease: basic and clinical perspectives. London, United Kingdom, Future Medicine Ltd, pp. 8–17.
- Hayashino, Y., Izumi, K., Nishimua, R., Okamura, S., Origasa, H. & Tajima, Naoko. (2016) Duration of diabetes and types of diabetes therapy in Japanese patients with Type 2 diabetes; The Japan Diabetes Complication and its Prevention prospective study 3. Journal of Diabetes Investigation. [Online] 8(2), 243-249. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5334313/. [Accessed on 20th January 2021]
- Huizen, J. (2019). The average age of onset for type 2 diabetes. [Online] Available from: https://www.medicalnewstoday.com/articles/317375 [Accessed on 17th January 2021].
- International Diabetes Federation. (2017). IDF Diabetes Atlas, 8th ed. Available from: https://diabetesatlas.org/upload/resources/previous/files/8/IDF_DA_8e-EN-final.pdf.
- Journal of Endocrinology, metabolism, and diabetes of South Africa. (2017). The 2017 SEMDSA Guidelines for the Management of Type 2 Diabetes, 22(1). Available from http://www.jemdsa.co.za/index.php/JEMDSA/article/view/647
- Levy, N. & Gillibrand, W. (2019). Management of diabetic foot ulcers in the community: an update, British Journal of Community Nursing, 24(3):1–14. DOI: 10.12968/bjcn.2019.24.
- Lu, Z. & Su, J. (2010). Clinical data management: Industry perspectives' current status, challenges, and future directions. Journal of clinical trials, 2010(2): 93-105. DOI: https://doi.org/10.2147/OAJCT.S8172
- Masic, I., Miokovic, M. & Muhamedagic, B. (2008). Evidence-based medicine-new approaches and challenges, 16(4): 219-225. DOI: 10.5455/aim.2008.16.219-225.
- McAra, S. (2011). Patient awareness of the loss of protective sensation in the diabetic foot: an opportunity for risk reduction? [Online] Available from: https://www.researchgate.net/publication/257882790_Patient_awareness_of_loss_of_protective_sensation_in_the_diabetic_foot_an_opportunity_for_risk_reduction. [Accessed 17th January 2021]
- Mbatha, M. (2017). Diabetes is the focus of the Durban Wellness Festival. SABCnewsonline. Available from http://www.sabcnews.com/sabcnews/durban-wellness-festival-increased-awareness-on-diabetes.
- Mehta, S. R., Kashyap, A. S. & Das, S. (2009). Diabetes mellitus in India: The modern scourge. National Library of Medicine, 65(1): 50-54. DOI: 10.1016/S0377-1237(09)80056-7
- Mokena, T. P., Mowa, C. N. & Subrina. (2017). Prevalence of Diabetic Foot Ulcers and Associated Risk Factors at Charlotte Maxeke Johannesburg Academic Hospital. MTech (Podiatry). [Unpublished]: University of Johannesburg. Retrieved from https://ujcontent.uj.ac.za/vital/access/services/Download/uj:30911/SOURCE1 .
- Monteiro-Soares, M., Vaz-Carneiro, A., Sampaio, S. & Dinis-Ribeiro, M. (2012). Validation and comparison of currently available stratification systems for patients with diabetes by the risk of foot ulcer development. European Journal of Endocrinology, 167: 401–407. Available from https://pubmed.ncbi.nlm.nih.gov/21249490/.
- Ntuli, S., Swart, A. & Lambert, C. V. (2018). Risk factors for diabetic foot ulceration. South African Journal of Diabetes and Vascular Diseases, 15(1): 32-36. Available from https://hdl.handle.net/10520/EJC-10055042ca
- Purbhoo, M. & Swart, A. (2015). Foot health-related quality of life of patients utilizing podiatric services at public health care facilities in Gauteng, South Africa. MTech. (Podiatry). [Unpublished]. The University of Johannesburg. Retrieved from https://ujcontent.uj.ac.za/vital/access/services/Download/uj:22554/SOURCE1
- Ramkisson, S., Pillay, B. & Sartorius, B. (2016). Psychosocial stress in South African patients with type 2 diabetes. Journal of Insulin Resistance 1(1). [Online] DOI: 10.4102/jir.v1i1.17
- Ramanathan, R. S. (2017). Correlation of duration, hypertension, and glycaemic control with microvascular complications of diabetes mellitus at a tertiary care hospital. Integral Mol Med 4. [Online] Available from https://www.oatext.com/Correlation-of-duration-hypertension-and-glycemic-control-with-microvascular-complications-of-diabetes-mellitus-at-a-tertiary-care-hospital.php#Article_Info. [Accessed 20th January 2021].
- Sahadew, N. & Singaram, V. S. (2019). Progress in diabetes care in the KwaZulu-Natal public healthcare sector: a decade of analysis. Journal of Endocrinology, Metabolism and Diabetes of South Africa, 24(3): 83-91. DOI: https://doi.org/10.1080/16089677.2019.1629080
- Shearman, C.P. (2015). Management of Diabetic Foot Complications, Springer-Verlag, London, 2015.
- Simmons, H. (2019). Diabetes in Men versus Women. [Online] Available from: https://www.news-medical.net/health/Diabetes-in-Men-versus-Women.aspx#:~:text=Diabetes%2C%20especially%20type%202%2C%20is,a%20greater%20risk%20of%20death.&text=Glucose%20is%20usually%20metabolised%20and,a%20pancreatic%20hormone%20called%20insulin. [Accessed 17th January 2021].
- Statista Research Department. (2020) Share of respondents with diabetes in India 2019 by age group. [Online] Available from: https://www.statista.com/statistics/1119414/india-share-of-respondents-with-diabetes-by-age-group/#:~:text=As%20per%20the%20results%20of,to%20have%20diabetes%20that%20year. [Accessed 17th January 2021].
- Tang, U. H., Zugner, R., Lisovskaja, V., Karlsson, J., Hagberg, K. & Tranberg, R. (2015). Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes are at high risk to develop foot ulcers. National Library of Medicine, 17(6), 257-293. DOI: 10.3402/dfa.v6.27593
- Tumbo, J. M. & Kadima, F. N. (2013). Screening of long-term complications and glycaemic control of patients with diabetes attending Rustenburg Provincial Hospital in North West Province, South Africa. African Journal of Primary Health Care & Family Medicine, 5(1) [Online] Available from https://phcfm.org/index.php/phcfm/article/view/375
- Thompson, A. T., Zipfel, B. & Aldous, C. (2021). The dysmorphic metatarsal parabola in diabetes - clinical examination and management: a narrative review. Journal of Endocrinology, Metabolism, and Diabetes of South Africa, 26(2), 40-45. DOI: https://doi.org/10.1080/16089677.2021.1897226
- Van Wyk, H. & Mostert, S. (2018). Poor diabetes management. South African Journal of Diabetes, 11(2), 16-21. [Online] Available from https://www.cdediabetes.co.za/uploads/cgblog/id27/SAJD_2_2018_No_ads.pdf
- Vascular centre. (2019) Diabetes Diabetic Foot. [Online] Available from: https://www.vascularcentre.co.za/diabetic-foot/. [Accessed 19th January 2021].
- Vileikyte, L. (2001). Diabetic foot ulcers: A quality of life issue. Diabetes/Metabolism Research and Reviews, 17(4), 246-249. https://www.researchgate.net/publication/11801169_Diabetic_foot_ulcers_A_quality_of_life_issue. [Accessed 31 March 2021}
- Vinik A., Casellini C. & Nevoret M. L. (2018). Diabetic Neuropathies. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279175/.
- World Health Organisation (WHO). (2019) Diabetes. Available from https://www.who.int/news-room/fact-sheets/detail/diabetes. [Accessed on 19 September 2019].
Yates, B. (2012). Merriman’s Assessment of the Lower Limb. 3rd ed. Churchill Livingstone. Elsevier Inc.