Prevalence of risk factors for development of angiopathy of lower extremities in Type 2 Diabetes patients: a mixed methods study

Abstract

Introduction: Diabetes Mellitus is one of the most common non-communicable diseases in the world and it is reaching epidemic proportions worldwide. Complications affecting the lower extremities are among the most common manifestations of diabetes; it was reported that 15% of diabetes patients eventually suffer from foot ulceration during their lifetime. About 60% of all lower extremity amputations in the United States are performed on persons with diabetes. According to the WHO, diabetes morbidity and mortality in Armenia have been steadily increasing over the past decade. Chronic diseases accounted for 90% of all deaths in 2002, and 6% of all deaths resulted from diabetes. Objectives: To identify the prevalence of risk factors leading to the development of angiopathy of lower extremities in Type 2 diabetes patients aged 40 years and older and to make recommendations to reduce diabetes foot complications. Methods: This study utilized a mixed methods approach with a case-control study conducted in Hospital and Polyclinic of Police, with 197 cases and 197 controls, and 22 in-depth interviews with family members of diabetes patients. The case control study collected data using telephone interviews. Results: The analysis of the quantitative research showed that the risk of having diabetic angiopathy of lower extremities increased with one year increase in duration of the disease (OR=1.14; 95% CI: 1.03; 1.25), with one-unit increase in BMI (OR=1.20; 95% CI: 1.08; 1.34), and with smoking one more cigarette per day (dose-response relationship) (OR=1.11; 95% CI: 1.07; 1.17). There was statistically significant association between diabetic angiopathy of lower extremities and poor self-monitoring of blood glucose level (OR=2.78; 95% CI: 1.51; 7.83) and presence of hypertension (OR=6.10; 95% CI: 2.26; 22.44). The odds of diabetic angiopathy of lower extremities was 10 times higher (OR=10.20; 95% CI: 2.61; 30.51) among those diabetes patients who did not check feet on a regular basis from the moment they were diagnosed with diabetes. In-depth interviews revealed a low level of knowledge of diabetes patients’ family members regarding the diabetes management, diabetes complications and their prevention. Many respondents found that health professionals provided little information to persons diagnosed with diabetes, making it difficult for those persons to understand how to manage diabetes. Most of the respondents often quoted financial issues as the cause of poor patients’ compliance with medication and diet. Conclusion: This mixed methods study showed that multiple factors and mechanisms contribute to the development of diabetic angiopathy of lower extremities in Type 2 diabetes patients. Poor foot self-checking following the diagnosis of diabetes, poor blood glucose control, current smoking level, presence of hypertension, BMI, and duration of the disease were predictive risk factors for antipathy of lower extremes in Type 2 diabetes patients. The role of health care providers was reported to be essential, particularly as patients seemed to need more information and guidance regarding the diabetes management.