Category: Diabetes/Prediabetes/Hypoglycemia

Monitor: 18

18 - PREVALENCE AND DETERMINANTS OF DIABETIC FOOT AMPUTATION IN NIGERIA

Thursday, Apr 25
11:30 AM – 12:00 PM

Objective :

Lower extremity amputation (LEA) is a potential sequelae of diabetic foot ulceration (DFU) and is associated with huge morbidly and mortality. We sought to determine amputation rate and risk factors for LEA in patients hospitalized for DFU in Nigeria, a typical  developing country. 


Methods :

The Multi-center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was a one year prospective study among patients hospitalized for DFU in six tertiary healthcare institutions between March 2016 and April 2017. Demographic characteristics and diabetes-related information, and ulcer characteristics including site, size, duration and Wagner grade were documented. Patients were evaluated for neuropathy and peripheral arterial disease (PAD) by standard methods while comprehensive laboratory and imaging tests were conducted. patients received appropriate multi-disciplinary care and were followed up until discharge or death. Outcome variables of interest included ulcer healing, LEA, duration of hospitalization and mortality.


Results :

A total of 336 patients (66% male) with a mean age of 55.9 ± 12.5 years were enrolled into the study. Majority (96.1%) had type 2 diabetes. Only 20.4% of the subjects had knowledge of proper foot care prior to development of ulcer. The median (IQR) duration of ulcer at presentation was 39 (28 - 54) days. Ulcers were advanced {Wagner grades ≥ 3) in 79.2% of the participants at the time of admission and 79.8% had wound infection. Seventy-nine subjects (34.3%) suffered LEA. Ulcer duration more than 1 month prior to hospitalization was the strongest predictor of LEA (O.R. 10.02, 95% C.I. 4.66 – 21.57, P < 0.001). Other significant determinants of LEA were ulcer grade 3 and above (P < 0.001), presence of peripheral arterial disease (P < 0.001), wound infection (P 0.041), presence of osteomyelitis (P < 0.001) and proteinuria (P 0.021).


Discussion :

Owing to recent advances in diabetes care globally, the burden of DFU has significantly declined in developed countries.  In Australia for instance, LEA rate from DFU range from 1-1.7% and majority are minor amputations. Similar trends are also reported in Europe and America.  Although the amputation rate of 34% observed in this study appears to be lower than the scenario about two decades ago when LEA rates as high as 53% were documented in Nigeria, our data suggest that significant progress has not been recorded in this direction. 


Conclusion :

The prevalence of LEA in Nigeria is still unacceptably high. Foot care knowledge is very low among patients and late presentation to the hospital is a major contributor to LEA. 

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Ejiofor Ugwu

Consultant Physician/Endocrinologist
Enugu State University Teaching Hospital, Enugu, Nigeria
Enugu, Nigeria

I am a consultant Physician Endocrinologist and Diabetologist at Enugu State University Teaching Hospital, Enugu, Nigeria. I am also a senior lecturer at the depertment of Internal Medicine, College of Medicine, Enugu State University of Science and Technology. I am the National Vice president of Diabetes Association of Nigeria.

Olufunmilayo O. Adeleye

Consultant Physician/Endocrinologist
Lagos State University Teaching Hospital. 1-5 Oba Akinjobi Way , Ikeja Lagos Nigeria
Lagos, Lagos, Nigeria

I am a Consultant physician Endocrinologist. I graduated from the College of Medicine University of Lagos. I am a fellow of the West Africa College of Physicians.

Ibrahim Gezawa

Consultant Physician/Endocrinologist
Aminu Kano Teaching Hospital
Kano, Nigeria

I am an associate professor of medicine and a consultant endocrinologist at the College of health sciences, Bayero University Kano and Aminu Kano Teaching Hospital, Kano.

Innocent ONOJA.. Okpe

Consultant Physician/Endocrinologist
Ahmadu Bello University Teaching Hospital
Zaria, Kaduna, Nigeria

consultant physician/endocrinologist and Senior Lecturer at the Ahmadu Bello University , a foremost University in Northern Nigeria and center of excellence.

Ignatius Ezeani

Consultant Physician/Endocrinologist
Federal Medical Center Umuahia
Umuahia, Abia, Nigeria

consultant physician / endocrinologist

Marcelina Enamino

Consultant Physician/Endocrinologist
Federal Medical Center Keffi

Consultant Physician/ Endocrinologist

Ejiofor Ugwu

Consultant Physician/Endocrinologist
Enugu State University Teaching Hospital, Enugu, Nigeria
Enugu, Nigeria

I am a consultant Physician Endocrinologist and Diabetologist at Enugu State University Teaching Hospital, Enugu, Nigeria. I am also a senior lecturer at the depertment of Internal Medicine, College of Medicine, Enugu State University of Science and Technology. I am the National Vice president of Diabetes Association of Nigeria.