Studying major amputations in a developing country using Amit Jain's typing and scoring system for diabetic foot complications - time for standardization of diabetic foot practice

Abstract

It is estimated that around 347 million people in the world are diagnosed with diabetes mellitus. 1 Indian is one of the country with very high prevalence of diabetes in the world which is predicted to increase to 120.9 million by 2030. 2 It is estimated that approximately 23.6 million people in United States have diabetes mellitus. 3 It is predicted that 1 in 3 American adults will have diabetes by 2050. 4 Diabetes affect 3% of the UK population. 5 Diabetic foot is one of the most common and distressing complication of diabetes. This devastating complication has major medical, social and economic consequences. 5 Around 15% of diabetic patients will develop foot ulcer during their life time. 6 Around 6% of hospital admission in people who have diabetes are related to foot ulcers. 7 Every year 5% of the patients with diabetes will develop a foot ulcers. 5 Foot ulcers are known to carry a 25% risk of major amputation. Diabetic foot ulceration is known to precede amputation in 85% of the cases. 8 Around 40% of the patients presenting to hospital with diabetic foot will require some form of amputation. 9 In ABSTRACT Background: Aim of current study was to analyse major amputation occurring in patients with diabetic foot complication through the new principle and practice of diabetic foot. Methods: A 5 year retrospective study was done in a single surgical unit in department of surgery of St John's medical college, Bangalore, India. Results: 26 patients were included in this study. 76.9% of the patients who underwent major amputation had type 1 diabetic foot complications. Infected ulcers were the most common cause for major amputation. Most patients who underwent major amputation had a score ranging from 16-20. 11.54% of the patients who underwent major amputation had osteomyelitis with type 3C diabetic foot osteomyelitis being most common. Conclusions: This unique study for the first time utilizes the new Amit Jain's principle and practice of diabetic foot to study major amputation in diabetic foot. Majority of the patients who undergo major amputation in India has type 1 diabetic foot complication. Most of the patients undergoing major amputation belongs to the high risk category for major amputation.

Application of Amit Jain’s Scoring System in Diabetic Foot Amputees

“…Our study showed that major amputations were common in similar to Jain et al series. [9] Below knee amputation was the commonest amputation in our series and also in Jain et al series. [9] The commonest cause for major amputation in this study was wet gangrene.…”

Survey of Foot Complications among Patients Attending Diabetic Foot Clinic in A Tertiary Care Center

“…Around 15% of diabetic patients will develop foot ulcers in their life time and this is known to cause amputation in 85% of the cases, in India approximately 45,000 lower limbs are amputated every year due to diabetic foot complications [14] .…”

Amit Jain’s system of practice for diabetic foot: the new religion in diabetic foot field

“…8,13,20 The surgical scoring has 16 factors and it includes clinical, anatomical, radiological and surgical finding that is unique of this scoring system. 20 Various studies have shown that more than 80% of major amputation done in diabetic foot had a score or more than 16.…”

“…[16][17][18] Studies also concluded that type 1 diabetic foot complication are the most common cause of major amputations in developing country like India, with 76.9% of patients who underwent major amputation had type 1 diabetic foot complication. 8,16 Jain et al also showed for the first time that type 1 diabetic foot complication are the most common cause of mortality (78.38%). 19 Nather et al failed to review and refer these studies in his article suggesting how to choose a classification with advantages and disadvantages of various classifications on diabetic foot.…”

“…6,7 The author developed a new principle and practice of diabetic foot for improvising and standardizing diabetic foot practice around the world. 8,9 Later various other concepts were added converting it into Amit Jain's system of practice of diabetic foot. [10][11][12] With development of various new concepts and a system in diabetic foot quite distinct from all other concept in the diabetic foot from western literature, the author grouped his entire work into a different system thereby converting it into a new religion for diabetic foot which could be followed by any health care professional around the world who believed in these new concepts and who wants to incorporate it in his practice.…”