Characteristics of patients with diabetic foot in Mombasa, Kenya

Abstract

Objective: To study the causes of perceived high mortality in patients with diabetic foot in Mombasa, Kenya. Design: A retrospective study. Setting: The Mombasa Hospital Private Clinics, from January 2001 to December 2005. An urban set up. Subjects: Ninety five patients with diabetic foot disease out of 830 in-hospital patients admitted with diabetes mellitus, aged between 40 and 90 years, treated mainly at The Mombasa Hospital. Intervention: Patients were managed conservatively and operatively. The operations were incision and drainage, debridement and amputation. Results: The majority of the males were between 50-70 years (76%) while the majority of the females were between 60-80 years (69%), with the mean age for males of 58 years and 65 years for the females. Overall mortality was 13%. Post-amputation mortality was 28%. The mortality was found to be associated with high co-morbidity, mainly uncontrolled diabetes mellitus (100%), Sepsis (75%), ischaemic heart disease (42%), uncontrolled hypertension (25%) and renal insufficiency (25%). The measurable characteristics included high blood sugars, raised WBC count, high creatinine, high serum lipids, abnormal ECG and abnormal arterial Doppler scans. Conclusion: The mortality associated with diabetic foot ulcer disease may be predicted by measurable characteristics. These parameters point to conditions that are themselves complications of diabetes mellitus and whose management will reduce mortality. The management of diabetic foot is therefore, multidisciplinary. Amputation appears to carry an added risk and should not be rushed until the patient is fully resuscitated.