Risk factors and outcomes of diabetic foot ulcer among diabetes mellitus patients admitted to Nekemte referral hospital, western Ethiopia: Prospective observational study

Bekele, Firomsa; Chelkeba, Legese; Fekadu, Ginenus; Bekele, Kumera

doi:10.1016/j.amsu.2020.01.005

Cited by 44 publications

(54 citation statements)

References 28 publications

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“…This finding is in line with studies done in Ethiopia. 28,29 But it was higher than the studies conducted in Japan, 54 England 55 and Iran. 33 This difference might be because of the difference in the denominator population and the study area because all the compared studies were populationbased but the current study was institution-based.…”

Section: Discussionmentioning

confidence: 64%

“…23 In different sub-Saharan African countries, the prevalence of DFU ranges from 3.4% to 18.1% [24][25][26][27] and studies conducted in different parts of Ethiopia showed that the prevalence of DFU ranges from 12 to 17.86%. [28][29][30][31] Studies indicated that DFU is affected by sociodemographic factors, clinical factors, and comorbidities. Among socio-demographic factors male sex, 32,33 being in the older age group, [34][35][36] and rural residency 28,31 are related to a higher risk of DFU.…”

Section: Introductionmentioning

confidence: 99%

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<p>Incidence of Diabetic Foot Ulcer and Its Predictors Among Diabetes Mellitus Patients at Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia: A Retrospective Follow-Up Study</p>

Adem¹,

Andargie²,

Teshale³

et al. 2020

DMSO

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The incidence of a diabetic foot ulcer (DFU) is increasing over the previous decade with an increasing prevalence of diabetes mellitus (DM). Despite the increasing incidence of DFU, there is limited information about the problem in Ethiopia. Hence, this study aimed to investigate the incidence of DFU and its predictors among newly diagnosed DM patients who were on follow-up at Felege Hiwot Referral Hospital. Methods: Institution-based retrospective follow-up study was conducted at Felege Hiwot Referral Hospital among newly diagnosed DM patients from January 1, 2009, to December 31, 2018. A simple random sampling method was used to select 401 study participants from a total of 723 eligible population. Data was entered using Epi-Data version 3.1 and exported to STATA version 14 for analysis. The incidence rate was estimated using person-years of observation and Nelson-Aalen cumulative hazard function, showing the cumulative probability of diabetic foot ulcer, was done. The best model (Gompertz) was selected using the AIC and log-likelihood method. Hazard ratio (HR) with its 95% confidence interval was computed and variables having a p-value less than 0.05 in the multivariable model were considered to be significantly associated with DFU. Results: A total of 387 patients were followed retrospectively for a median follow-up time of 95 months. Out of all, 66 (17.05%) patients developed DFU with an incidence rate of 4 cases per 100 person-years of observation. Diabetic nephropathy (adjusted hazard ratio (AHR) = 2.37, 95% CI: 1.33-54.24), diabetic retinopathy (AHR = 5.56, 95% CI: 2.64-11.74), and increased body mass index (AHR = 1.13, 95% CI: 1.01-1.27) were found to increase the hazard of DFU. Conclusion: The incidence of DFU was relatively high. Diabetic nephropathy, diabetic retinopathy, and body mass index were its significant predictors. Therefore, close monitoring of patients with co-morbidities and increased body mass index should be considered to reduce DFU.

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Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

<p>Incidence of Diabetic Foot Ulcer and Its Predictors Among Diabetes Mellitus Patients at Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia: A Retrospective Follow-Up Study</p>

Adem¹,

Andargie²,

Teshale³

et al. 2020

DMSO

View full text Add to dashboard Cite

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“…A total of 34(29.57%) of the diabetes foot ulcer were overweight and 16(13.91%) were obese while the mean body mass index (BMI) was 24.94 ± 3.69 kg/m 2 . From the sites of ulcers involved, a total of 67(58.26%) of them were developed over plantar toes/foot whereas, 31(26.96%) of ulcers were located on dorsal/interdigital toes, 9(7.83%) of the diabetes foot ulcers were located in the dorsal foot and 8(6.96%) of the ulcers were developed over heel [ 16 ]. The mean fasting blood glucose level among diabetic patients with foot ulcers was 147.93 ± 45.03 mg/dl and a total of 56(48.69%) diabetes foot ulcers had a diabetes complication.…”

Section: Resultsmentioning

confidence: 99%

“…From the total diabetes foot ulcer patients, a total of 77(67%) of ulcers were progressed to infection and 38(33%) of them did not. From the patients who developed an infection, gram- positive organisms were identified in 42(54.55%), gram-negative were identified in 20(25.97%) and polymicrobial were seen in 15(19.48%) [ 16 ].…”

Section: Resultsmentioning

confidence: 99%

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

Bekele

Chelkeba

2020

Journal of Foot and Ankle Research

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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.

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“…Although there is a decreasing trend in the annual incidence of LEAs caused by T2DM 5 , the cost of ulceration and amputations attributable to diabetes reached $10.9 billion in 2001 6 . Several risk factors are correlated with DFCs, such as severe peripheral arterial disease (PAD) 7 , poor glycemic control and neuropathy 8 , and foot deformity 9 . A prospective study with a follow-up period of 10 years observed that the risk of first major amputation for DFC patients with PAD was 35 times higher than the risk for those without PAD 7 .…”

Section: Introductionmentioning

confidence: 99%

Family history of diabetes is associated with diabetic foot complications in type 2 diabetes

Xiong

Wei

Xiao

et al. 2020

Sci Rep

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To investigate the relationship between diabetic foot complications (DFCs) and clinical characteristics, especially the number and types of first-degree family members with diabetes. A total of 8909 type 2 diabetes patients were enrolled. The clinical characteristics of these patients, including DFCs and family history of diabetes (FHD), were collected from medical records. Multiple regression was used to investigate the association between FHD and DFCs after adjusting for confounding factors. The patients with one and more than one first-degree family member with diabetes accounted for 18.7% and 12.8%, respectively. The proportions of the participants with a father with diabetes, a mother with diabetes, both parents with diabetes, siblings with diabetes, father and siblings with diabetes, mother and siblings with diabetes, and both parents and siblings with diabetes were 3.5%, 6.2%, 1.1%, 14.4%, 1.5%, 4%, and 0.7%, respectively. The multiple regression analysis showed that the number of family members with diabetes was positively associated with DFCs. However, among the different types of FHD, only the patients with a mother with diabetes showed a statistical association with DFCs. In addition to FHD, other factors, including gender, body mass index, platelet count, hemoglobin levels, albumin levels, high-density cholesterol levels, diabetic peripheral neuropathy, and the use of lipid-lowering agents, oral hypoglycemic agents, and insulin, were also associated with DFCs. DFCs were associated with different numbers of family members with diabetes and types of FHD. This association reveals the importance of genetic and environmental factors in DFCs and highlights the importance of adding FHD to public health strategies targeting detecting and preventing the disease.

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Risk factors and outcomes of diabetic foot ulcer among diabetes mellitus patients admitted to Nekemte referral hospital, western Ethiopia: Prospective observational study

Cited by 44 publications

References 28 publications

<p>Incidence of Diabetic Foot Ulcer and Its Predictors Among Diabetes Mellitus Patients at Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia: A Retrospective Follow-Up Study</p>

<p>Incidence of Diabetic Foot Ulcer and Its Predictors Among Diabetes Mellitus Patients at Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia: A Retrospective Follow-Up Study</p>

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

Family history of diabetes is associated with diabetic foot complications in type 2 diabetes

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