Diabetic foot is a common diabetic complication and a major cause of diabetes-related disability, but there are few reports about awareness of diabetic foot and foot self-management behavior in Wagner grade 0 diabetic foot patients.
To analyze the awareness of diabetic foot, level and associated factors of foot self-management behavior in Wagner grade 0 diabetic foot patients in the community.
A total of 500 outpatients with Wagner grade 0 diabetic foot were selected from Changning District Xinhua Subdistrict Community Health Center from January to June 2021, to attend an on-site survey using a questionnaire developed by us, for understanding their knowledge of diabetic foot and approaches used to acquire the knowledge, as well as foot self-management behavior. Multiple linear regression analysis was used to analyze the associated factors of foot self-management behavior.
The response rate was 100.0% (500/500) . The awareness rate of diabetic foot and average foot self-management behavior score of the respondents were 53.2% (266/500) , and (20.1±6.2) , respectively. The awareness of diabetic foot in the respondents differed by age, educational level, course of diabetes, and prevalence of receiving diabetes health education (P<0.05) . The foot self-management behavior score in the respondents differed by age, educational level, marital status, monthly per capita household income, course of diabetes, and prevalence of receiving diabetes health education (P<0.05) . Multiple linear regression analysis results demonstrated that, age (β=0.242) , educational level (β=0.417) , marital status (β=-0.175) , monthly per capita household income (β=-0.075) , course of diabetes (β=0.175) , and diabetes health education (β=-0.173) were associated with foot self-management behavior score (P<0.05) . The major approaches to acquiring knowledge of diabetic foot were guidance from the family doctor or community nurse (62.2%) , searching the Internet (33.2%) , and watching television/listening to the radio (30.6%) .
In Wagner grade 0 diabetic foot patients in the community, the awareness rate of diabetic foot is relatively low. Moreover, the level of foot self-management behavior is also relatively low, which may be associated with many factors, such as age, educational level, marital status, monthly per capita household income, course of diabetes, and diabetes health education.
Diabetic retinopathy (DR) may cause vision loss, visual field defects, vitreous hemorrhage, and even blindness. However, there are few reports about delayed healthcare-seeking in patients with DR.
To analyze the influencing factors of delayed healthcare-seeking and visiting time in DR patients.
DR patients were recruited from Tianjin Eye Hospital from January to May 2018, to attend an anonymous questionnaire survey for understanding their healthcare-seeking status, and delay in healthcare-seeking (taking visiting time over 5 years as delayed healthcare-seeking) . Influencing factors of delayed healthcare-seeking were explored using multinomial ordinal Logistic regression analysis with the stepwise method.
The survey achieved a response rate of 94.5% (120/127) . Among the 120 respondents, the visiting time was less than 1 year in 9 cases, 1 to 2 years in 11 cases, 3 to 5 years in 17 cases, and over 5 years in 83 cases; the prevalence of delayed healthcare-seeking was 69.1% (83/120) . The visiting time differed significantly by educational level, monthly income, place of residence, course of diabetes, vision, classification of diabetic macular edema, status of blood glucose monitoring, and prevalence of hypertension (P<0.05) . Multinomial ordinal Logistic regression analysis with the stepwise method showed that, place of residence〔OR=3.395, 95%CI (1.362, 7.053) 〕, vision〔OR=1.526, 95%CI (1.086, 2.775) 〕, prevalence of hypertension〔OR=1.307, 95%CI (1.002, 5.376) 〕, classification of diabetic macular edema〔OR=5.537, 95%CI (1.897, 9.534) 〕and status of blood glucose monitoring〔OR=2.582, 95%CI (1.271, 6.882) 〕were associated with the visiting time (P<0.05) .
The prevalence of delayed healthcare-seeking is high in patients with DR, which may be influenced by place of residence, vision, prevalence of hypertension, classification of diabetic macular edema and status of blood glucose monitoring.
Patients with diabetic kidney disease (DKD) are more prone to anemia than those with non-diabetic kidney disease. Anemia quickens the progression of DKD, and is closely associated with cardiovascular disease and other complications. So studying the influencing factors of anemia in DKD is of great importance to the reduction of anemia incidence and the delaying of DKD progression.
To investigate the influencing factors of anemia in DKD.
Two hundred and fifty-four inpatients with DKD were selected from Department of Nephrology, First Affiliated Hospital of Kunming Medical University from January 2019 to September 2020. Data of them were retrospectively collected, including demographic information 〔gender, age, height, weight, blood pressure, duration of diabetes, calculated body mass index (BMI) , and smoke prevalence〕, and laboratory test indices 〔red blood cells (RBC) , serum hemoglobin (Hb) , total protein (TP) , albumin (ALB) , globulin (GLB) , alkaline phosphatase (ALP) , cholinesterase (CHE) , uric acid (SUA) , blood urea nitrogen (BUN) , creatinine (Scr) , cystatin C (Cys C) , retinol binding protein (RBP) , fasting plasma glucose (FPG) , calcium (Ca) , phosphorus (P) , magnesium (Mg) , zinc (Zn) , iron, unsaturatediron binding capacity (UIBC) , total iron binding capacity (TIBC) , ferritin, transferrin (TRF) , C-reactive protein (CRP) , and erythrocyte sedimentation rate (ESR) , glycated hemoglobin (HbA1c) , UALB/CRE, 24-hour urine for microalbumin (24 h-mALB) , 24-hour urine for total protein (24 h-MTP) 〕 and estimated glomerular filtration rate (eGFR) . One hundred and sixteen cases were diagnosed with anemia, and 138 without (anemia was defined as serum Hb≤130 g/L for men, and ≤120 g/L for women) . Spearman rank correlation analysis and multiple linear regression analysis were used to explore the factors associated with anemia in DKD.
Compared with patients without anemia, those with anemia had higher systolic blood pressure, and longer duration of diabetes (P<0.05) . Moreover, anemia patients had lower levels of RBC, Hb, TP, ALB, GLB, CHE, eGFR, serum Ca, Zn, iron, UIBC, TIBC, ferritin, and TRF, and higher levels of BUN, Scr, Cys C, RBP, FPG, serum P, Mg, CRP, ESR, and HbA1c, UALB/CRE, 24 h-mALB, as well as 24 h-MTP (P<0.05) . Spearman rank correlation analysis showed that Hb was positively correlated with TP, ALB, CHE, eGFR, FPG, serum Zn, and iron, UIBC, TIBC, and ESR (P<0.05) and negatively correlated with SBP, duration of diabetes, BUN, Scr, serum Cys C, P, CRP, HbA1c, UALB/CRE, 24 h-mALB, and 24 h-MTP (P<0.05) . Multiple linear regression analysis showed that duration of diabetes (β=-0.060) , ALB (β=0.755) , CHE (β=1.512) , Zn (β=1.173) , and HbA1c (β=-5.766) in serum, and eGFR (β=0.341) were independently associated with serum Hb in DKD (P<0.05) .
Anemia in DKD may be associated with the duration of diabetes, serum levels of ALB, CHE, Zn and HbA1c, as well as eGFR. The above-mentioned influencing factors should be actively corrected to reduce the incidence of anemia and to improve the quality of life in DKD patients.
