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Nursing ResearchLiterature ReviewName :____________________________________Tutor :_____________________________________Tutorial Group :_____________________________Plagiarism :________________________________Student ID :________________________________Introduction :Diabetic foot syndrome is a common complication of diabetes and is linked to many symptoms associated with progressive loss of sensation in feet (Khan, Junaid). It is more common in those with chronic diabetes mellitus or those with inappropriate treatment. With inappropriate treatment, it may cause delayed recovering of ulcers, inflammation, unnecessary surgical intervention and lower limb amputation (Nehring et al.) On top of that, it can lead to more worse complications such as Charcot neuroarthropathy and osteomyelitis (Khan, Junaid). Also, it is known to be the most expensive diabetes mellitus complication to treat (Al-Maskari, El-Sadig).Research shows that prevalence of foot ulcers has been reported to affect 4.0% to 10.0% in patients with diabetes with the lifetime risk in these patients being as high as 25.0% (Khan, Junaid). However, based on a research done by Al-Maskari,El-Sadig and Abouaesh et al., diabetic foot is present in 15% of general population with diabetes.The research on diabetic foot syndrome on people with type 2 diabetes is relevant as it is estimated that around 5.37% of the adult population suffers from type 2 diabetes. More doctors, nurses and the public should be more aware and understanding of the risk factors that are present in diabetic foot syndrome and not only does it reduce the chances of people to suffer from it, the healthcare industry can also improve on its treatment and prevention methods based on the compiled studies of other healthcare professionals.  The aim of this review is to assess the prevalence and risk factors of diabetic foot in patients diagnosed with diabetes mellitus type 2.Risk factors in type 2 diabetes patientsBased on a study in 2007 by Al-Maskari and El-Sadig, of a sample of 513 diabetic patients with mean ages of 53, had underwent interviewer-administered questionnaires and medical assessments. With both feet being examined for skin status such as dryness and cracking. Deformities, gangrene, amputation, and nail status were also noted. Peripheral neuropathy was assess by pressure, pain, vibrations. For pressure, the tools used were the 10 g Semmes-Weinstein monofilaments on 4 sites without calluses. For vibrations, a 128 Hz tuning fork was applied on 3 sites on the foot. If the patient had felt a vibration, it would be considered normal. However, anything else besides vibrations would be considered abnormal. A test was also conducted using the diabetic neuropathy symptom (DNS) and diabetic neuropathy examination (DNE) to define and assess neuropathy. All in all, the prevalence of foot complications was 199 (39%), who had peripheral neuropathy which was higher than the equivalent rates reported in other populations and 59 (12%) had peripheral vascular disease.Similarly, in a research done in 2017 by Khan and Junaid, with a sample size of 230 subjects where 94 were male and 136 were female and an overall mean age of 53.82 +/- 9.96 and average duration of diabetes being 7.87 +/- 5.50 years. A brief history of previous diabetic foot ulcer, amputation, gangrene, deformity and current ulceration were recorded. Similarly to Al-Maskari and El-Sadig’s research, physical examination of both foot was conducted by assessing dryness, cracking, calluses, blisters or any infection. The same tools were used, the 10g Semmes-Weinstein monofilament for sensation and 128 Hz tuning fork to elicit vibrations. Subjects were categorized into 4 different categories. Category 0 being patients with no evidence of neuropathy, category 1 being patients with neuropathy but no evidence of foot deformity or peripheral vascular disease, category 2 being patients with neuropathy and evidence of deformity and peripheral vascular disease and category 3 being patients with a history of foot ulcerations or lower extremity amputation. After assessment, diabetic foot syndrome was observed in 32 patients, 37 patients in category 1, 6 patients in category 2, 32 in category 3 and 148 in category 0. However, the most common findings observed in the physical assessment was dryness of the skin in 71 patients and discoloration or pigmentation in 36 patients. In conclusion, a high prevalence of diabetic foot syndrome was observed, with low rate of prescription of insulin for patients with diabetic foot syndrome, implying low awareness of appropriate treatment options even in healthcare providers dealing with patient’s routine care.However, when compared to a study conducted by Nehring et al. in 2014, which compares groups of patients with diabetic foot syndrome, patients with type 2 diabetes without diabetic foot syndrome and healthy controls, it yield different results. Of the 900 subjects, 145 had diabetic foot syndrome, 293 had diabetes type 2 without diabetic foot syndrome and 462 was healthy controls. A physical assessment for neuropathy was conducted for temperature, touch, pain and vibration. Results has shown that the presence of diabetic foot was increased by the male gender and the protecting factor was a patient’s age and hyperlipidaemia. On the other hand, the risk factors for developing type 2 diabetes in a general population were weight. Furthermore, it has shown that risk factors for type 2 diabetes and diabetic foot are only partially common. Patients who are more likely to develop diabetic foot experience different risk factors than patients who are at risk of diabetes. Also, with the identification of the relationship between diabetic foot and diabetes risk factors, it may help clinicians pinpoint on preventing diabetic foot syndrome.ConclusionIn conclusion, it has shown that there is a high prevalence of diabetic foot syndrome in adults (Khan, Junaid). On top of that, they also experience different symptoms than those who are developing type 2 diabetes (Nehring et al.). Furthermore, even with the absence of foot ulceration and amputation, a substantial amount of subjects had potential risk factors for foot complications (Al-Maskari, El-Sadig). Also, future healthcare professionals would be more aware and understanding of the risk factors that is present in not only those diagnosed with type 2 diabetes, but also those who are at risk of developing type 2 diabetes. As shown in the research paper by Nehring et al., by identifying a relationship between diabetic foot and diabetes risk factors, it may help clinicians or nurses to focus on factors in prevention of diabetic foot syndrome while the patients are admitted to our wards. This can potentially prevent further harm to the patient while also treating the most expensive diabetes complication as stated by Al-Maskari and El-Sadig. In addition, the compilation of these 3 papers can be used as statistical evidence in education in schools and hospitals to educate the future nurses and those who are at potential risk of developing type 2 diabetes or diabetic foot syndrome.References :Article 1 : 2 : 3 :