Risk factors for lower extremity ulcer in the morbidly obese diabetic patients

OBJECTIVE: To assess risks associated with lower-extremity ulcers (LEU) among veterans with diabetes (DM) who used either inpatient or outpatient care in the Veterans Health Administration (VHA) in 2003. This study expands prior research by examining morbid obesity (MOB) and other chronic conditions as LEU risk factors.

METHODS: VHA Medical SAS Datasets for fiscal year 2003 were used to extract all patients with DM (ICD-9-CM 250.xx).

RESULTS: There were 347,477 VHA users with DM whose body mass index (BMI) status could be ascertained. 34,667 patients had LEU in 2003 for a prevalence rate of 9.80%. We found that age  85, male sex, the presence of chronic heart failure, Charcot joint, and deficiency anemia, all significantly increased the risk of LEU, while black race, married status, and the presence of hypertension, coronary artery disease, and chronic obstructive pulmonary disease were associated with lower risk. Compared with patients without MOB, those with MOB (BMI ≥40 kg/m2) were 58% more likely to have LEU. Diabetic neuropathy (DN) and peripheral artery disease (PVD) had the strongest effect on LEU risk among all predictors. Interaction terms between MOB and DN, and DN and PVD had significantly elevated risks of LEU with OR = 8.348 and OR = 18.408, respectively. CONCLUSION: Three key co-morbid conditions, DN, PVD, and MOB, combined to increase the risk of LEU significantly more than the sum of the effects of individual conditions in isolation. Rigorous DM control and weight reduction are keys to prevent LEU.