Amputation rate of diabetic foot ulcer and associated factors in diabetes mellitus patients admitted to Nekemte referral hospital, western Ethiopia: prospective observational study

Abstract

Background Diabetes foot ulcer is a devastating and much-feared complication of diabetes. Diabetes foot ulcerations which developed gangrene can take weeks or months to heal and can sometimes not heal at all so that amputation for non-traumatic causes is a frequent outcome in the diabetic foot. Despite this, there is no finding on predictors of the amputation rate of diabetes foot ulcers in Ethiopia. Hence this study was aimed to identify factors associated with the amputation rate of diabetes foot ulcer patients in Nekemte referral hospital. Patients and methods A prospective observational study was conducted among adult diabetes foot ulcer patients admitted to Nekemte referral hospital from March 15 to June 15, 2018. A pus swab was obtained from the ulcers before any ulcer cleaning to conduct gram staining. The primary outcome was the amputation rate. Cox regression analysis was used to estimate the hazard ratios and time from study entry to healing was evaluated as censored event times by Kaplan-Meier curves. Result Over the study period, 115 diabetes foot ulcer patients were admitted to the NRH; of these patients, 64(55.65%) were males while the mean age of participants was 44.4 ± 14.7. A total of 34(29.57%) of the diabetes foot ulcer were overweight and 16(13.91%) were obese while the mean ± standard deviation of body mass index (BMI) was 24.94 ± 3.69 kg/m2 and a total of 56(48.69%) diabetic foot ulcer had a diabetic complication. Of patients with diabetic foot ulcer, 35(30.43%) were undergone lower extremity amputations (LEA). Patients who were prescribed with inappropriate antibiotics were unlikely to heal. A total of 18(46.15%) of the patients who were taken inappropriate antibiotics were healed whereas 21(53.85%) were not healed (P = 0.017). Besides, the higher the Wagner grade, the worse the outcome of healing. A total of 19(21.84%) and 16(57.14%) of patients with grade < 4 and grade ≥ 4, respectively, did not heal (P = 0.005). Conclusion The amputation rate of diabetes foot ulcers was rapid for patients prescribed inappropriate antibiotics and higher grades of the foot ulcer. Therefore, the presence of clinical pharmacists plays a pivotal role to promote the appropriate use of antibiotics and besides the daily care, special attention should be given for patients having an advanced grade of diabetes foot ulcer.

Serum exosomes accelerate diabetic wound healing by promoting angiogenesis and ECM formation

“…To improve the quality of life of diabetic patients, development of the effective treatments for diabetic complications has been necessary and urgent. Diabetic ulcers, the most common diabetic complication, a devastating medical problem which may lead to amputation (Alexiadou & Doupis, 2012; Bekele & Chelkeba, 2020; Guo et al, 2019). Traditional treatments include the control of blood glucose levels and healing management, but the therapeutic effect remains limited (Everett & Mathioudakis, 2018).…”

Association between Lipid Profile and Apolipoproteins with Risk of Diabetic Foot Ulcer: A Systematic Review and Meta-Analysis

“…It is expected that by 2030, the prevalence will increase to 10.2% and, by 2045, to 10.9% [ 1 ]. Among the most important complications of diabetes, the diabetic foot ulcer (DFU) emerges as a growing problem for public health systems since it is a leading cause of hospitalization and amputation in patients with diabetes [ 2 ]. Globally, the prevalence of DFU is estimated at 6.3%, and the highest prevalence has been found in North America (13.0%) [ 3 ].…”

Foot self‐care behaviour in type 2 diabetes adults with and without comorbid heart failure

“…Infection and greater severity of DFU are associated with increased risk of amputation and mortality (Brennan et al, 2017 ; Ndosi et al, 2018 ). Studies have reported the rate of lower extremity amputation as high as 30.43% among DM patients with DFU in Ethiopia (Bekele et al, 2020 ; Bekele & Chelkeba, 2020 ). Both DFU and its ensuing infections increase the risk of emergency department visits and hospital admissions (Skrepnek et al, 2017 ).…”