Prospective exploration of the effect of adiposity and associated microbial factors on healing and progression of diabetic foot ulcers in Tanzania: study protocol of a longitudinal cohort study

Abstract

BackgroundDiabetic foot ulcers (DFUs) are associated with high morbidity and mortality in low-income countries. This coexists with an increasing prevalence of obesity which has been reported to alter antimicrobial susceptibility and potentially affect the outcome of infected foot ulcers. This study aims to determine whether adiposity and local microbial factors affect the progression and healing of foot ulcers in people with type 2 diabetes in hospital settings in Tanzania.Methods and analysisA prospective cohort of 300 individuals with type 2 diabetes presenting with DFUs at an outpatient clinic will be enrolled into the study. At baseline, participants will be stratified into normal and high adiposity groups (150 per group) as measured by bioelectrical impedance analysis (BIA). Both groups will receive DFU management according to locally appropriate standards of care and will be followed up for 24 weeks or until complete wound healing, whichever occurs first. The primary end point is complete wound healing at 24 weeks while secondary end points are ulcer progression (worsening or improving), amputation and death. Enrolling 150 participants per group will have a minimum power of 80% to detect a 20% difference in cumulative incidence of complete ulcer healing (at the 5% level of statistical significance) between the normal and high adiposity groups.Ethical considerations and dissemination of resultsThis study will be conducted in compliance with the independent institutional review boards (IRBs), informed consent guidelines, the declaration of Helsinki and International Conference on Harmonisation, Good Clinical Practice Guidelines. Ethical clearance has been granted by the Muhimbili University of Health and Allied Sciences ethical review board (MUHAS Ref. No. DA.282/298/01 .C/). Permissions to conduct the study have been granted by the Abbas Medical Centre and the Muhimbili Academic Medical Centre (MAMC).Progress and results emanating from this work will be communicated to the scientific community through conference presentations, short communications (using journal letters and interesting case reports) and peer-reviewed publications. When necessary, through proper channels, popular means of communication (newspapers, magazines and online communications) will be used to inform policy and the public.Trial registration number NCT03960255; Pre-results.

Prevalence of diabetes foot ulcers and associated factors among adult diabetic patients in three referral hospitals in Mogadishu, Somalia

“…However, people who do not receive family assistance for diabetes care have over three times the odds of having DFUs than those who do. A prior review of the literature stated that family support is an integral part of sustaining self-management behaviors and improving the health outcomes of diabetes patients ( 24 ). In Somalia, professional support services, such as nurse visits or disease education programs, are supposed to provide invaluable support for patients with diabetes are often unavailable.…”

Tunga penetrans causing a rapidly progressing foot ulcer in a patient with uncontrolled type 2 diabetes mellitus

“…This case was first noticed from an ongoing recruitment of patients into a longitudinal study on diabetic foot ulcers [ 10 ]. The study is funded by a project grant from the GSK Africa Non-Communicable Disease Open Lab (project number: 8806) and the GlaxoSmithKline R&D (Africa Non-Communicable Disease Open lab grant).…”