Determinants of diabetic foot ulcer among persons with diabetes mellitus attending an outpatient clinic in a Nigerian tertiary hospital: A cross-sectional study

ABSTRACT Background: Diabetic foot ulcer (DFU) is one of the common complications of diabetes mellitus (DM) and a leading cause of nontraumatic amputations worldwide. With a higher prevalence in developing countries like Nigeria, DFU causes significant morbidity and mortality to patients while also causing socioeconomic distress to them, their families, and the health system. This study aims to identify risk factors for the development of DFU among DM patients attending an outpatient clinic in a tertiary hospital in Lagos, Nigeria. Methods: A cross-sectional study was conducted with 296 DM patients attending the Lagos University Teaching Hospital outpatient clinic. Data were collected using structured interviewer-administered questionnaires, clinical foot examinations, and anthropometric and biochemical measurements. Risk factors for DFU were analyzed using SPSS version 25; P ≤ 0.05 was considered statistically significant. Results: The mean age of participants was 60.58 ± 11.3 years, with 61.8% being female. 7.8% of patients had a history of previous DFU. Visual impairment (63.2%), inappropriate footwear (51.7%), and skin dryness (52%) were common risk factors identified in participants. Using binary logistic regression, we found that both duration of diabetes and the presence of foot crackles were independent predictors of foot ulceration. Specifically, longer duration of diabetes was associated with an OR of 3.133 (95% CI: 1.164–8.434; p = 0.024), and presence of crackles on the feet with an OR of 3.095 (95% CI: 1.066–8.987; p = 0.038). Other factors — including inappropriate footwear and dry skin with dilated veins — showed increased odds of foot ulceration but did not reach statistical significance ( p = 0.074 and p = 0.080, respectively). Patients who wear inappropriate footwear or have dry skin with dilated veins are more likely to have foot ulcers, although not statistically significant ( P = 0.074 and P = 0.08, respectively). Conclusion: Regular screening for DFU risk factors and prevention strategies targeting microvascular and macrovascular complications are crucial. A multimodal approach is essential for effective DFU prevention in DM patients.