Analysing patient factors and treatment impact on diabetic foot ulcers in South Africa

Abstract

In the South African public healthcare sector, 28% of diabetic patients present to primary healthcare clinics with diabetic foot ulcers (DFUs), often presenting in advanced stages of ulcer severity. In this study, we aimed to categorise factors predisposing individuals to developing a DFU and to identify the potential shortcomings in existing treatment plans in the South African healthcare system. In addition, the use of preventative measures in the management of DFUs was examined as well as the influence of past treatment practices. A total minimum sample size of 50 DFUs was required for this study. Participants who were selected for this study had their past records reviewed in order to determine the likelihood of previous DFU infections, as well as to determine the occurrence of co-morbidities. The treatment protocol implemented was recorded. Twelve-month patient records were used to identify the infection frequency and past treatment protocols. A total of 48.9% of patients reported that they did not make use of any preventative measures. The most frequent concurrent medical conditions were hypertension, dyslipidaemia, and peripheral neuropathy. Polypharmacy was prevalent, with 55% of the population prescribed five or more medications. Potential medication interactions were examined and a total of 210 interactions were documented. An analysis of past and current treatment practices revealed that 52.1% of the treatment protocols did not comply with local treatment guidelines. This study highlights the urgent need for updated DFU treatment protocols in relation to the overall management of DFUs, taking into account existing international guidelines.

Significance:

We determined that the South African treatment guidelines and DFU classification system do not align to international standards. Furthermore, the use of preventative measures among DFU patients was poor and polypharmacy was present in the patient cohort. We emphasise the need for all members of a healthcare team, including podiatrists, clinicians, microbiologists and pharmacists, to work together in order to identify at-risk patients, prevent possible DFUs and effectively treat existing DFUs in a manner that does not contribute to antimicrobial resistance and provides the best possible outcome for the patient.