Magnitude of limb loss attributable to diabetes mellitus in a tertiary institution in Nigeria

Abstract

Background: Diabetes mellitus (DM) and its complications, continues to pose enormous challenge to health and financial stability.  Diabetes has remained a source of national and global economic burden. It has been observed lately that incidence of diabetic foot ulcer  (DFU); one of the complications of DM, is on the increase and it is contributing hugely to financial loss, morbidity and mortality among  diabetic patients. This is taking a great toll on affected individuals in terms of cost of treatment, deformities sustained, number of  working/productive days lost while on admission and its attendant economic implications, and ultimately mortalities recorded. The aim  was to determine the magnitude of limb loss or lower extremity amputation attributable to DM over a period of 12 months in tertiary  institution and to assess the clinical profile of the patients. Method: This is a retrospective study of the records of all patients that were  consecutively booked for lower limb amputation and operated upon in the last 12 months at UNIOSUN Teaching Hospital, Osogbo, South-Western Nigeria. Out of these total, cases of DFU were extracted to form another study group and then studied in detail. Results:  Atotal of 38 patients had lower limb amputation from July 2021 to May 2022. Twenty three of the total number of amputations had DFU  with a huge proportion of 60.5%, followed by road traffic accident with 28.9% (n=11) Of the 23 diabetic cases , females were 15 with M:F  ratio of 1:1.9. Mean age was 63±11.18 years. Mean duration of DM was 8.06±5.64 years. 78.3% had no foot care education and Doppler  USS confirmed atherosclerosis in 100% of the patients. The commonest bacteria isolated was Proteus 34.8%. Length of hospital stay  ranged between 6 weeks to 16 weeks. Outcome of admission was largely successful with 95.7% discharged and 4.3% mortality.   Conclusion: DFU contributes markedly to morbidity and mortality. Long duration of DM, presence of PAD and DPN as well as  advancement in age and wound infection with proteus bacterial are observed to be risk factors associated with gangrenous DFU.  However, larger studies are needed to establish these factors as predictors of amputation in patient with DFU. Outcome was majorly  good as majority of the patients were discharged.