The effect of glycated hemoglobin control on diabetic foot complications.

Objectives The study aimed to evaluate the association between diabetic foot complications (DFCs) incidence and glycated hemoglobin (HbA1c%) control among outpatients with type 2 diabetes. Research Question is that: Is there an association between uncontrolled glycemia (HbA1c% >7) and DFCs? Methods A cross-sectional study established at Hospital Pulau Pinang, Malaysia, July 2016–2017. A cohort of 223 cases with HbA1c >7 and group of 177 subjects with HbA1c% ≤7 were guided by American Diabetes Association 2016 Guidelines. Demographics, laboratory and foot examination data were collected from the patients’ records. A diabetologist assessed DFCs. DFCs were defined as diminishing or/and loss of protective sensation, foot deformity and callosity, foot fungal infection, foot ulcer, and amputation. IBM-SPSS 23.0 was used for data management. Results The mean of age for 400 patients was (52.3±14.8) years and 60% of them had DFCs. DFCs were (43.5%) diminishing or/and loss of protective sensation, (34.5%) foot deformity and callosity, (5.8%) foot fungal infection, (5.8%) foot ulcer, and (3.5%) amputation. Of 223 patients with HbA1c% >7, about 148 (66.4%) cases had DFCs, 0.66 (95% CI: 0.6 – 0.73). However, from 177 patients with HbA1c ≤7, only 92 (52%) subjects had DFCs, 0.52 (95% CI: 0.45 – 0.59). The relative risk of HbA1c% >7, for the incidence of DFCs, is (RR: 1.28, 95% CI: 1.1 – 1.5) and excess relative risk is (27.7%). The absolute risk is (14.4%), and number needed to harm is 7. Chi-square test indicated a significant difference between the means of two cohorts in DFCs incidence (P-value: 0.001). Spearman’s correlation is significant, (r: 0.146, p-value: 0.003). Multinomial logistic regression indicated HbA1c >7% as a significant predictor of DFCs (rs: 0.021, p-value: 0.004). Conclusions This analysis demonstrated that more than half of the patients have DFCs. Patients with HbA1c >7 have a higher risk of DFCs