Clinical profiles of diabetic foot ulcer patients undergoing major limb amputation at a tertiary care center in North-eastern Tanzania

Abstract

Background Diabetic foot ulcers complications are the major cause of non-traumatic major limb amputation. We aimed at assessing the clinical profiles of diabetic foot ulcer patients undergoing major limb amputation in the Surgical Department at Kilimanjaro Christian Medical Centre (KCMC), a tertiary care hospital in North-eastern Tanzania. Methods A cross—sectional hospital-based study was conducted from September 2018 through March 2019. Demographic data were obtained from structured questionnaires. Diabetic foot ulcers were graded according to the Meggitt-Wagner classification system. Hemoglobin and random blood glucose levels data were retrieved from patients’ files. Results A total of 60 patients were recruited in the study. More than half (31/60; 51.67%) were amputated. Thirty-five (58.33%) were males. Fifty-nine (98.33%) had type II diabetes. Nearly two-thirds (34/60; 56.67%) had duration of diabetes for more than 5 years. The mean age was 60.06 ± 11.33 years (range 30–87). The mean haemoglobin level was 10.20 ± 2.73 g/dl and 9.84 ± 2.69 g/dl among amputees. Nearly two thirds (42/60; 70.00%) had a haemoglobin level below 12 g/dl, with more than a half (23/42; 54.76%) undergoing major limb amputation. Two thirds (23/31; 74.19%) of all patients who underwent major limb amputation had mean hemoglobin level below 12 g/dl. The mean Random Blood Glucose (MRBG) was 13.18 ± 6.17 mmol/L and 14.16 ± 6.10 mmol/L for amputees. Almost two thirds of the study population i.e., 42/60(70.00%) had poor glycemic control with random blood glucose level above 10.0 mmol/L. More than half 23/42 (54.76%) of the patients with poor glycemic control underwent some form of major limb amputation; which is nearly two thirds (23/31; 74.19%) of the total amputees. Twenty-eight (46.67%) had Meggitt-Wagner classification grade 3, of which nearly two thirds (17:60.71%) underwent major limb amputation. Conclusion In this study, the cohort of patients suffering from diabetic foot ulcers treated in a tertiary care center in north-eastern Tanzania, the likelihood of amputation significantly correlated with the initial grade of the Meggit-Wagner ulcer classification. High blood glucose levels and anaemia seem to be also important risk factors but correlation did not reveal statistical significance.

Individualized Approaches to Diabetes Care in Nursing Homes

“…Even if you have chosen to forgo treatment, you should still get your blood sugar levels checked if anything changes in how you feel 93 . The American Diabetes Association, the Société Francophone du Diabete, and the European Association for the Study of Diabetes all recommend adapting therapy objectives to the patient's motivation, risk of hypoglycemia and other side effects, diabetes history, life expectancy, co-morbidities, cardiovascular consequences and financial resources if treatment is selected 90 . Given the intricacy of the factors involved, an official individual, and the various consideration for diabetic assessment and care in nursing homes summarize in table 2.…”

Individualized Approaches to Diabetes Care in Nursing Homes

“…Even if you have chosen to forgo treatment, you should still get your blood sugar levels checked if anything changes in how you feel 93 . The American Diabetes Association, the Société Francophone du Diabete and the European Association for the Study of Diabetes all recommend adapting therapy objectives to the patient's motivation, risk of hypoglycemia and other side effects, diabetes history, life expectancy, co-morbidities, cardiovascular consequences, and financial resources if treatment is selected 90 . Given the intricacy of the factors involved, an official individual, and the various consideration for diabetic assessment and care in nursing homes summarize in the table.…”

Distribution and drug sensitivity of pathogenic bacteria in diabetic foot ulcer patients with necrotizing fasciitis at a diabetic foot center in China

“…Diabetic foot ulcer (DFU) is one of the major complications for patients with diabetes, and has become an important cause of non-traumatic amputation [ 1 – 4 ]. Most patients with DFUs display peripheral vascular disease or diabetic neuropathy, and have impaired immunity [ 5 , 6 ].…”