Burden, risk factor and outcomes of diabetic foot ulcer in diabetes mellites patients admitted to Nekemte referal hospital, east wollega zone,west Ethiopia

Abstract

BACKGROUND: Diabetic foot ulcer are very common in people with diabetes throughout the world, affecting up to 15% of diabetic patients during their lifetime. Foot ulcers significantly contribute to morbidity and mortality of patients with diabetes mellitus. The diabetic patients with foot ulcers require long-term hospitalization and carry the risk of limb amputation. The presence of peripheral neuropathy ,peripheral vascular disease, and poor glycemic control in conjunction with minor foot trauma increases the likelihood that patients with diabetes will develop foot ulcers. OBJECTIVE: To identify burden, risk factor and outcomes of diabetic foot ulcer in diabetes patients of Nekemte referral hospital (NRH) from March 15 to June 15, 2018. METHODS AND PARTICIPANTS: A general prospective cohort study of diabetes mellitus patients who had diabetic foot ulcer was conducted in Nekemte referral hospital from March 15 to june 15, 2018. Study participants were selected by using convenience or haphazard sampling technique. The Wagner classification of diabetic foot ulcer was used to assess the severity of foot ulcers. Size of ulcer was determined by multiplying the largest by the second largest diameter perpendicular to the first and the etiology of diabetic foot ulcer was identified by using gram stains. Multivariate logistic regression was used to analyze the associations between dependent variable and independent variables. RESULTS: From 644 diabetes mellitus, 115 diabetes foot ulcer patients were admitted to the Nekemte referral hospital; of these patients, 64(55.65%) were male. About 26(22.61%) of them were in the age range of 58-67, while mean age of participants was 44.44 ±14.69. Regarding their area of residence, Fifty-eight (50.43%) participants came from urban area. Among the total study participants, 61 (53.04%) of them had type 2 diabetes mellitus. The mean fasting blood glucose level among diabetic patients with foot ulcer was 147.93mg/dl ±45.03. Gram-positive bacteria were the most causative micro organism for the diabetic foot infections which accounted for 42(54.55%). Ulcer size was greater than 5cm 2 in 23 (20.00%) of the patients. From diabetes patients evaluated during the study period, 17.86% had foot ulcers. Of these patients, 35(30.43%) were undergone amputations. Grade of diabetic foot ulcer[AOR=1.7; 95% CI: 1.604, II 4.789],inappropriate antibiotics[AOR = 2.526; 95% CI: 1.767, 8.314], Overweight [AOR = 2.767; 95% CI: 1.827, 9.252], obesity [AOR = 3.020; 95% CI: 2.556, 16.397],blood glucose control[AOR = 2.592; 95% CI: 1.937, 7.168], and neuropathy [AOR = 1.565; 95% CI: 1.508, 4.822] were found to be a predictor of amputation in multivariable logistic regression analysis. Cloxacillin was the most commonly prescribed antibiotics for treating diabetic foot ulcer accounting 56(34.15%) followed by metronidazole 43(26.22%) and ceftriaxone33 (20.12%). CONCLUSION AND RECOMMENDATION: The incidence and rate of amputation of diabetic foot ulcer among diabetic patients in Nekemte referral hospital was high. Blood glucose level, Higher BMI, inappropriate antibiotics given, neuropathy, and advanced grade of diabetic foot ulcer were factors that predict outcomes of diabetic foot ulcer. The most commonly prescribed antibiotics for treating diabetic foot ulcer was cloxacillin. Gram positive bacteria were the most isolate organism. Provision of special emphasis for patients having neuropathy and advanced grade of diabetic foot ulcer, decreasing excessive weight gain, managing hyperglycemia, and appropriate antibiotics prescription practice would decrease outcomes of diabetic foot ulcer.