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History of and factors associated with diabetic foot ulcers in Norway: The Nord-Trøndelag Health Study

Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway, marjolein.iversen{at}hib.no, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway

Kristian Midthjell

The HUNT Research Center, Norwegian University of Science and Technology, Verdal, Norway

Truls Østbye

Department of Community and Family Medicine, Duke University Medical Center, Durham, USA

Grethe S. Tell

Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway

Elizabeth Clipp

School of Nursing, Duke University Medical Center, Durham, USA

Richard Sloane

Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, USA

Monica W. Nortvedt

Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway

Sverre Uhlving

Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway

Berit R. Hanestad

Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway

Aims: To determine the proportion of people with diabetes mellitus reporting a history of foot ulcer and to investigate factors associated with this adverse outcome. Methods: All inhabitants aged 20 years and older residing in a large geographic region were invited to participate in the Nord-Trøndelag Health Study, 71% (n=65,604) attended. Those reporting diabetes (n=1,972) were invited to take part in an ancillary study on diabetes. Based on 1,494 responses to the question: ``Have you had a foot ulcer that required more than three weeks to heal'', the proportion with a history of foot ulcer was estimated. Results: The overall proportion with a history of foot ulcer was 10.4% (95% CI 8.8—11.9%). In the final multivariate logistic regression model, significant factors for a foot ulcer history included age 75 years (OR 1.8, 95% CI 1.2—2.8), height (men>175 cm, women>161 cm) (1.9, 95% CI 1.3—2.8), gender (male) (1.5, 95% CI 1.03—2.2), using insulin (1.6, 95% CI 1.1—2.4), and macrovascular complications (1.8, 95% CI 1.2—2.6). Conclusions: The proportion of people reporting a history of foot ulcer in this population-based study exceeded the proportion of foot ulcer history reported previously. Height as a correlate has been occasionally reported in previous studies and needs further attention. Associated factors for a foot ulcer history help identify individuals who may be at particular risk of this adverse outcome.

Key Words: Diabetes mellitus • foot ulcer • population study • risk factors

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