| Summary: | 碩士 === 長庚科技大學 === 林口校區護理系碩士在職專班 === 107 === Limb-threatening (LT) foot ulcers are extensive cellulitis in diabetic foot infections, which can result in extremely high amputation rates and mortality. Climate change may affect functional activity in human, coagulation factors, blood pressure or lipids that may change due to seasonal variation. The main purpose of this study was to investigate the association between LT foot ulcers and seasonal variation, including temperature and humidity in diabetic foot patients.
We retrospectively reviewed patients treated at a major diabetic foot center in northern Taiwan. The medical records and the classification of the wound were collected. The patients were classified into two groups: LT diabetic foot ulcer (LT DFU) and diabetic foot ulcer (DFU). The LT DFU was defined according to the PEDIS classification of the wound, including grade 3.4 of infection (I) or grade 3 of perfusion (P). The data of monthly average temperature and relative humidity were collected from the four weather stations in the north via Central Weather Bureau. The four seasons are divided according to the astronomical season and the climate season. All data analyses were conducted using SPSS version 22.0 with chi-square, student t test, Spearman’s correlation, and multiple logistic regression.
Of the 732 cases treated in the diabetic foot center, 645 (88.1%) had LT DFUs and the remaining 87 (11.9%) had DFUs. Two groups in the basic properties, peripheral arterial disease (58.4% in LT DFUs, 40.2% in DFUs, p < 0.01) and hyperlipidemia (34.7% in LT DFUs, 46% in DFUs, p < 0.05) were significantly different. LT DFUs had higher CRP than DFUs (96.69mg/L and 39.77 mg/L, p < 0.001). LT DFUs had higher rate of major amputations than DFUs (p < 0.05).
The number of hospitalized patients with diabetic foot disease in different month was significantly negatively correlated with the mean temperature when hospitalization (rs = -.0447, p<0.05), but no significant correlation with humidity. In the spring, the number of admissions for diabetic foot ulcer was the highest (x2=10.393, p<0.05), but autumn was the season with the highest incidence of LT DFUs (x2=8.145, p<0.05). We further analyzed with logistic regression analysis which revealed that the month, the season (Autumn), peripheral arterial disease, and C-reactive protein (CRP) are the predictors of LT DFUs.
The results of this study found that spring is the peak of admission to diabetic foot disease. As the temperature is warmer than winter, it may increase daily activity in diabetic patients and repetitive foot pressure increases the risk of foot injury, thus increasing the risk of developing diabetic foot in spring. Autumn is the season with the highest incidence of LT DFUs. It may be due to warmer temperatures in 2016-2017, the average temperature in autumn is 25.53°C, and the relative humidity is 78.88%. The warm and humid weather increases the risk of LT DFUs. It is recommended that clinical health care workers should strengthen the protection of foot protection in the spring and autumn in order to reduce the incidence of diabetic foot and LT DFUs, thereby reducing the amputation rate and mortality in diabetic patients.
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