Diabetic foot disease in Ethiopian patients: A hospital based study

Abstract

Background: Ulcers of the foot are one of the most feared and common complications of diabetes. It is a major cause of disability, morbidity and mortality among diabetic patients and about 15% develop foot ulcers in their lifetime. So far, there are few published data in relation to the high-risk diabetic foot in Ethiopian subjects. Methods: A retrospective study was done to determine the various risks as well as antecedent factors, other long term complications, treatment profile and subsequent follow up of 196 patients with diabetic foot disease admitted to the Tikur Anbessa Specialized Referral Hospital from Jan 1999 to Dec 2003. Patients' medical records were reviewed using pre-prepared formats and relevant data were abstracted. The data were analyzed using Epi info version 3.4.3 statistical soft ware. Results: A total of 196 patients were included in this study. The male to female ratio was 3 to 1. The median age was 60 years (IQR, 47-65). Median duration of symptoms before presentation was 21 days (IQR, 14-30) and the median duration of diabetes mellitus was144 months (IQR, 60-216). More than two thirds had type 2 diabetes mellitus. Among 109 patients with identified antecedent risk factors for their foot problem, ill fitting or new shoes attributed in 48(44%). Neuro-ischaemic ulcers were seen in 113 (58%) of the cases and neuropathic ulcer in 63 (32%). Ulcer with cellulitis or gangrene was the most common mode of presentation seen in 92 (47%) of the patients. Ninety two (47%) patients had amputations. Re-amputation was necessary in 24 (26%) of these cases. Less than 40% of the total cases had a regular follow up either at a clinic or hospital. Diabetes was diagnosed for the first time in 7 cases (4%) on presentation with foot ulcer. The mean glycemic level was poorly controlled in over 80% of the cases. The overall mortality rate was 21% and sepsis was the most identified cause. Conclusion: Lack of regular patient follow up and diabetes education on foot care, poor glycemic control, delay in patient presentation and surgical intervention as well as patients' refusal to undergo surgical interventions were the reported contributing factors for the observed high mortality. Recommendation: Diabetic education on foot care, emphasis on metabolic control of diabetes, early presentation and surgical intervention when appropriate has to be highlighted in the management of diabetic patients. More studies have to be done in relation to the high-risk diabetic foot particularly in the Ethiopian setting emphasizing on preventive aspects.