Establishment of the Brunei Diabetic Foot Registry

Abstract

The overall aim of this thesis was to characterise the clinical features of diabetic and non-diabetic foot ulcers in one of the largest tertiary public hospitals in Australia and establish the first Diabetic Foot Registry in Brunei Darussalam to explore incidence, risk factors and optimal treatment pathways for the local community. For the first study, a total of 195 outpatients with diabetic foot ulcers were extracted from the Westmead Hospital’s Foot Wound Clinic Registry. It was concluded that diabetic foot ulcers are more likely to present on the plantar surface of the foot with a duration of 1 week to 3 months and largely affect older, overweight males with a long standing history of diabetes. Our findings were in accordance with the EURODIALE benchmark study in Europe. In contrast to patients with diabetic foot ulcers, our results for 202 outpatients with non-diabetic foot ulcers largely affect, on average, elderly males and females with normal BMI, on the plantar and dorsal aspect of the foot with a duration of 1 week to 3 months. In comparison with diabetic foot ulcers, socioeconomic status was also not related. The final studies were conducted to validate the Brunei Diabetic Foot Registry. The validation process involved test-retest of all Registry items in 26 patients by four podiatrists in the Podiatry Unit in Brunei, and a prospective 6 month pilot study of 56 patients to assess content validity of 63 items. All continuous data items exhibited “excellent” reliability (ICC1,1>0.94) and 67% revealed “almost perfect” agreement of nominal data items. Pilot data demonstrated that the Registry items comprehensively covered the presence, severity and characteristics of the diabetic foot ulcer cohort. In conclusion, the findings of this thesis have implications for clinical and health policy decisions and emphasise the importance of accurate patient registries in determining incidence, characteristics and treatment pathways of patients with diabetic foot ulcers.