Ramya Kannan

Barefoot walking, non-use of customised footwear are reasons

The study was conducted among 2,642 patients Recurrence of infection is significantly higher among rural patients With rural patients, more aggressive education methods must be adopted

CHENNAI: Though incidence of diabetes in rural areas is lower than in urban centres, a combination of factors makes management of the disease and its complications more formidable among rural patients.

In India, diabetic foot infection, due to a variety of socio cultural practices, is a common cause for hospitalisation of diabetics.

A recent study conducted by the foot clinic of M.V. Hospital for Diabetes, Royapuram, among 2,642 patients showed that foot amputation rate among rural patients was higher than in urban areas. While 1,377 patients resided in cities, 1,265 lived in small villages.

All of them were diabetic for 12 years. They also had a high risk of amputation due to neuropathy (loss of sensation in the feet), a complication arising out of poorly controlled diabetes.

Foot infection

While the amputation rate was eight per cent among the rural patients, it was just three per cent among the urban ones. The prevalence of foot infection among the rural patients (34 per cent) was higher than the urban patients (26 per cent).

The findings published in the March edition of Diabetes Care, also indicated that during follow up over a period of two years, the recurrence of foot infection was significantly higher among rural patients (13 per cent) than urban ones (eight per cent).

The rate of repeat surgery for foot infection was 10 per cent among the rural patients and 6 per cent among the urban patients.

According to Vijay Viswanathan, joint director of the hospital, who led the research team, the main causes were lifestyle related, though both groups had received similar counselling and awareness communication.

The reasons could be attributed to greater barefoot walking in rural areas and lesser use of customised diabetic footwear.

Also, in the villages, sleeping on the floor led to frequent rat bites. Injuries caused thus will result in frequent hospitalisation and result in poor life quality.

Tough task

All these indicate that management of diabetes and its complications in a rural setting posed a formidable challenge, Dr.Viswanathan explained. Earlier studies had proved rather conclusively that increasing awareness on foot care among diabetics reduces ulceration and resultant surgical intervention or hospitalisation.

However, the current study had demonstrated that handling urban and rural patients similarly would not work. With rural patients, more aggressive patient education methods must be adopted.