Diabetic foot ulcer in a Tropical setting: Presentation and outcome

Abstract

Introduction: As a result of increasing urbanization and adoption of western lifestyles, the prevalence of diabetes with its attendant complications is increasing in the tropics.This is in particular fueled by poverty, low economic indicators and ignorance. There seems to be a looming explosion in the rate and prevalence of diabetic foot lesions over the next decade especially in developing countries using Nigeria as a surrogate. Objectives: To audit the pattern of presentation, bacteriology, management pattern and outcome of Diabetic Mellitus Foot ulcer (DMFU) in an urban tertiary care setting over a 5 year period (January 2005-December 2009). Method: This is a 5 years retrospective analysis of cases of Diabetes mellitus (DM) foot lesions managed at the medical and orthopaedic wards of the Ladoke Akintola University Teaching Hospital teaching hospital, Osogbo, Nigeria. Poor glyceamic control was defined as fasting blood glucose > 7 mmol/L on admission in a patient with a history of diabetes, while peripheral neuropathy was defined as reduced vibration and joint position sense or history of numbness of the extremities.
Result: A total of three hundred and thirty two patients with diabetes  mellitus (three hundred and twenty patients with Type 1 DM and twelve patients with Type 2 DM) were admitted in to our wards for various
ailments over a five year period (from January 2005 to December 2009), out of which 75 (22.6%) patients presented with diabetic foot lesions. Age range of the patients with this lesion was between 25 to 90 years. Staphyloccus aureus was the most commonly isolated organism on wound swab. 30(40%) patients had various degree of amputation and were subsequently discharged to the occupational/ limb prosthesis unit, 4 patients refused amputation, 18 patients died on admission, 18 patients were discharged home after conservative management. Conclusion: DM foot ulcers remains a major cause of morbidity and mortality amongst patients with diabetes in the medical wards. There is a need to encourage the regular use of portable Doppler scanners to detect early/ at risk cases as early as at diagnosis of diabetes, while emphasizing proper foot care and good glycaemic control.

Keywords: Diabetic foot, ulcer, tropical, presentation