Magnitude of limb loss attributable to diabetes mellitus in a tertiary institution in Nigeria
Keywords:
Diabetes, Diabetic foot ulcer, Amputation, Lower limb loss, Peripheral arterial diseaseAbstract
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; A total 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.
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