Clinical Outcomes of Diabetic Foot Ulcer: A 5-year retrospective analysis at a Tertiary Referral Hospital in Ethiopia.
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Date
2023-12
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Addis Ababa University
Abstract
Background
Diabetic foot ulcer is a common, serious, and costly complication of diabetes. It is the leading
cause of non-traumatic lower extremity amputation carrying a high risk of morbidity and mortality.
The clinical outcomes of diabetic foot ulcer in Ethiopia are not well studied. This study aimed to
assess the outcomes of diabetic foot ulcer at tertiary care setting in Ethiopia.
Methods
A retrospective study conducted including all consecutive patients with diabetic foot ulcer
admitted to a 642-bed tertiary hospital in Ethiopia from January 2018 to October 2022. Data were
collected using a pretested, structured questionnaire. Then, the open data kit (ODK) completed
form was exported and analyzed using SPSS version 25. Descriptive statistics were used to
describe participants’ characteristics. To identify determinants of lower extremity amputation,
bivariable and multivariable binary logistic regression analyses were done. Statistical significance
was considered at the level of significance of 5%, and adjusted odds ratio (AOR) with 95%
confidence interval (CI) was used to present the estimates of the strength of the association.
Results
A total of 146 participants were included (79.5% were males, mean (±SD) age was 59.4 (±11.7)
years). Glycemic goal achieved in 12.3% of patients while only 4.8% met their triple targets of
blood glucose, blood pressure and lipids. Lower extremity amputation was performed in 53.4% of
the patients with major amputation done for the overwhelming majority. In-patient mortality was
8.2%. Independent predictors of amputation were: long standing diabetes (duration ≥10 years:
Adjusted Odds Ratio: 2.42; [95% Confidence Interval: 1.01-5.80]), longer ulcer duration before
presentation (every week of delayed presentation: 1.14 [1.01-1.03]), history of previous foot ulcer
(4.34 [1.55-12.13]), advanced ulcer stages with University of Texas stage C or D (2.86 [1.19-
6.90]). There was statistically non-significant trend of increased risk of amputation with advancing
age and insulin treatment.
Conclusion: the rate of lower extremity amputation in diabetic foot ulcer was excessively high.
Long standing diabetes, ulcer duration, history of previous foot ulcer, and advanced ulcer severity
were significantly associated with amputation. Prompt attention to these risk factors may reduce
amputation rate among these patients. The high LEA rate in a low-income country indicates the
mega-disparity in preventive and limb saving interventions reflecting the global health inequity
that needs addressing.
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Keywords
Diabetic foot ulcer, lower extremity amputation, retrospective review, Ethiopia.