Diabetic foot ulcers (DFU) mainly occur due to repetitive stress on the foot from daily activity in the presence of peripheral neuropathy. Very few studies have investigated daily activity and energy expenditure in people with DFU. The aim of this case-control study was to investigate daily activity, energy expenditure and sleep in diabetes patients with DFU compared to those without DFU.
Participants with type 2 diabetes were recruited into three groups, those with: i) current neuropathic foot ulcers (DFU), ii) peripheral neuropathy without DFU history (DPN), and, iii) nil neuropathy or DFU history (NIL). Exclusion criteria included peripheral arterial disease and mobility aid use. Participants wore a SenseWear Pro 3 Armband continuously for 7 days and completed an Epworth Sleepiness Scale. The Armband is a validated automated measure of activity (steps, Metabolic Equivalent Tasks (MET), physical activity (>3 METs) duration), energy expenditure(kJ) and sleep (duration). Data on age, sex, BMI, diabetes duration and HbA1c were also collected.
Sixty-three (30 DFU; 21 DPN; 12 NIL) participants were recruited; 71% males, mean±SD age of 61±11 years, diabetes duration 13±9 years, HbA1c 8.3±2.8, BMI 33±6, average METs 1.2±0.2. No demographic differences between groups were reported, except mean age (57±11 DFU; 68±10 DPN; 60±9 NIL, p = 0.003). Significant differences were reported in mean±SD steps/day (3,271±2,417 DFU; 5,211±3,290 DPN; 6,052±2,521 NIL, p = 0.002) and daily energy expenditure(kJ) (13,0006±3,559 DFU; 11,074±1,962 DPN; 10,959±1,351 NIL, p = 0.006). No significant differences were reported for average METs, physical activity, sleep time or Epworth score (p > 0.1).
Conclusion and Clinical Relevance
Findings suggest people with diabetes foot ulcers are much less active, however, expend much more energy in doing so than those without a history of foot ulcers. Sleep parameters showed no differences. Further research is required to investigate the disproportionate daily activity and energy expenditure balance in people with diabetes foot ulcers.
Foot, ulcers, activity, energy, sleep