Amputation Risk Factors Among Patients With Diabetic Foot Attending A Tertiary Hospital, Dar Es Salaam, Tanzania

Abstract

Background: About 79% of the 463 million people who have diabetes globally live in low- and middle-income countries.
Along with the unprecedented growing burden of diabetes, the related complications such as diabetic foot affect up to
60 million adults. Diabetic foot complications are known to be the leading cause of non-traumatic amputation. This study
aimed to determine the risk factors of amputation among patients with diabetic foot admitted at a tertiary care hospital.
Methods: This hospital based retrospective study was conducted among patients with diabetic foot and required
admission between Jan 2017 to Dec 2020. The selection was based on availability within the specified period. Data
were retrospectively extracted from patient files and the hospital electronic database. The effect of risk factors was
analyzed using multiple linear logistic regression models. Variables included age, sex, type and duration of diabetes,
co-morbidities, pharmacological therapy, and diabetic complications. A P value <.05 was considered statistically
significant.
Results: A total of 56 adult patients with diabetic foot were seen at Shree Hindu Mandal Hospital between January
2017 and December 2020. Of them, 44 (78.6%) were male. The mean age was 60.6 (SD ±11.7) years, and the
mean duration of diabetes was 10.7 years. More than half 33 (58.9%) had their lower limb amputated and 66.7% of
the total amputated, were between 50-69 years old. Fifty-four patients (96.4%) had foot ulcers and about one third 10
(30.3%) had a previous history of amputation. Over two thirds of all patients 49 (87.5%) had poor glycemic control
with HbA1C above 6.5% and 31 (94%) of those who had amputation had their lower limb amputated. Patients with
gangrene were more likely to have amputation than those without gangrene (aRR 4.03, 95% CI 1.31, 12.43; P=.015).
Conclusion: Poor glycemic control and gangrene are important risk factors for amputation among patients with
diabetic foot. The study highlights the necessity for enhanced patient education on comprehensive foot care to prevent
amputations and improve patient outcomes. Targeted interventions focusing on glycemic control and early detection of
foot complications, especially in the elderly population, are urgently needed.