A Study on the Prevalence and Associated Factors of Diabetic Foot at-Risk in Patients with Type 2 Diabetes in Primary Care in Hong Kong

Background: Diabetes mellitus is a major global health issue, which can cause a wide range of complications. One of the most devastating complications is infected foot ulcer requiring lower limb amputation. Diabetic neuropathy - leading to loss of protective sensation and/or deformity, and peripheral vascular disease are major predisposing conditions, which increase the risk of development of foot ulcer. With an emphasis on preventive care, primary care strategies should be implemented to reduce risk of diabetic foot ulcer. A major preventive strategy would be to identify patients at risk, in order to enhance early intervention to reduce risk of development of diabetic foot ulcer. This study was performed to evaluate the prevalence of patients with type 2 diabetes who were identified at risk of developing foot ulcer “diabetic foot at-risk”, and the associated factors in primary care setting. Methods: A cross-sectional study was performed on all Chinese adult patients who attended diabetic complication assessment during period 1st July 2019 to 30th June 2022 in eight government primary care clinics in Hong Kong. The primary outcome was the prevalence of diabetic foot at-risk, based on the International Working Group on the Diabetic Foot (IWGDF) 2023 Risk Stratification System. The secondary outcome was the associated factors of diabetic foot at-risk. Results: 37,359 patients were included. The prevalence of diabetic foot at-risk was 7.6%, with 4.3%, 3.2% and 0.1% patients in IWGDF 2023 diabetic foot risk category 1, 2 and 3 respectively. 0.2% had active foot ulcer disease. Male, older age, current smoker, ex-smoker, obesity, HbA1c >7%, presence of diabetic retinopathy, presence of albuminuria or proteinuria were found to have significant positive association with diabetic foot atrisk. Regular physical activity of moderate intensity, taking lipid lowering drug were found to have significant negative association. Conclusions: Diabetic foot at-risk was not uncommon among patients in primary care. Optimization of the control of modifiable risk factors, and focus on management of pre-ulcerative conditions for at-risk patients should be adopted to prevent the development of foot ulcer.