Diabetic foot disease is a major medical, social, and economic problem. This retrospective study assessed the profile of diabetes mellitus patients with foot ulcers in the University of Calabar Teaching Hospital (UCTH), Nigeria. Admission records of all patients admitted unto the medical wards of UCTH over a 5 year period were analysed. The records of diabetic patients were retrieved. Data on patient characteristics and possible risk factors for diabetes mellitus foot ulcers was extracted. Of the 3,882 patients admitted, 297 (7%) were on account of complications of diabetes mellitus. Foot ulcers accounted for 63 (21.2%) of all diabetic admissions. The elderly constituted the majority of patients admitted with foot ulcers. The average duration of stay of diabetics with foot ulcers was 38.5 days. Diabetics admitted for other conditions had average duration of admission of 15.8 days. Staphylococcus aureus was the commonest organism isolated from swabs of foot ulcers. Most of the organisms identified from ulcer swab cultures were sensitive to quinolones and resistant to penicillins. These diabetic foot ulcers were significantly associated with peripheral sensory neuropathy, peripheral vascular disease, intermittent claudication, and walking barefoot. An effective diabetes foot programme is required to address these risk factors and reverse the current trend. 1. Introduction Diabetes mellitus (DM) remains a very common endocrine disorder with major public health consequences arising from severe damage to numerous end organs [1]. DM affects all populations worldwide and the prevalence of this disease is increasing at a very alarming rate [2, 3]. The International Diabetes Federation (IDF) currently estimates that about 366 million persons in the world have DM, with projections that this will increase to 552 million by 2030 [4]. The IDF estimated that there were 12.1 million people living with diabetes in Africa in 2010 with a projected rise to 23.9 million by 2030 [5]. In Nigeria, DM remains the most common chronic endocrine-metabolic disorder similar to what is found in other parts of the world [6, 7]. As the incidence of DM is rising dramatically worldwide, so is the incidence of diabetic foot disease [8]. Diabetic foot disease is a major medical, social, and economic problem, that is, seen in every continent and constitutes a major burden to the patient and the health care system [8]. The lifetime risk of a person with diabetes developing diabetes mellitus foot ulcers (DMFU) is reported to be as high as 25% [9]. In Nigeria, around 10% of people with
References
[1]
Y. Du, C. Heidemann, A. G？？wald, and P. Schmich, “Prevalence and comorbidity of diabetes mellitus among non-institutionalized older adults in Germany—results of the national telephone health interview survey ‘German Health Update (GEDA)’ 2009,” BMC Public Health, vol. 13, article 166, 2013.
[2]
M. J. Pinidiyapathirage, A. Kasturiratne, U. K. Ranawaka, D. Gunasekara, N. Wijekoon, and K. Medagoda, “The burden of diabetes mellitus and impaired fasting glucose in an urban population of Sri Lanka,” Diabetic Medicine, vol. 30, pp. 326–332, 2012.
[3]
C. E. Ekpenyong, U. P. Akpan, J. O. Ibu, and D. E. Nyebuk, “Gender and age specific prevalence and associated risk factors of type 2 diabetes mellitus in Uyo metropolis, South Eastern Nigeria,” Diabetologia Croatica, vol. 41, no. 1, pp. 17–28, 2012.
[4]
International Diabetes Federation (IDF), Diabetes Atlas, International Diabetes Federation, Brussels, Belgium, 5th edition, 2011, http://www.idf.org/diabetesatlas/5e/the-global-burden.
[5]
International Diabetes Federation (IDF), Diabetes Atlas, 2012, http://www.idf.org/diabetesatlas/africa.
[6]
S. Chinenye, A. E. Uloko, A. O. Ogbera, et al., “Profile of Nigerians with diabetes mellitus-Diabcare Nigeria study group (2008): results of a multicenter study,” Indian Journal of Endocrinology and Metabolism, vol. 16, no. 4, pp. 558–564, 2012.
[7]
C. N. Unachukwu and S. N. Ofori, “Diabetes mellitus and cardiovascular risk,” The Internet Journal of Endocrinology, vol. 7, no. 1, 2012.
[8]
A. J. M. Boulton, “The diabetic foot: a major problem for the new millennium,” West Indian Medical Journal, vol. 50, no. 1, pp. 21–23, 2001.
[9]
N. Singh, D. G. Armstrong, and B. A. Lipsky, “Preventing foot ulcers in patients with diabetes,” Journal of the American Medical Association, vol. 293, no. 2, pp. 217–228, 2005.
[10]
A. Ogbera, O. Fasanmade, and A. Ohwovoriole, “High costs, low awareness and a lack of care—the diabetic foot in Nigeria,” Diabetes Voice, vol. 51, no. 3, pp. 30–33, 2006.
[11]
A. O. Ogbera, A. Adedokun, O. A. Fasanmade, A. E. Ohwovoriole, and M. Ajani, “The foot at risk in Nigerians with Diabetes Mellitus: the Nigerian scenario,” International Journal of Endocrinology and Metabolism, vol. 4, pp. 165–173, 2005.
[12]
B. A. Solagberu, “The scope of amputations in a Nigerian teaching hospital,” African Journal of Medicine and Medical Sciences, vol. 30, no. 3, pp. 225–227, 2001.
[13]
S. O. Ogunlade, T. O. Alonge, A. B. Omololu, J. Y. Gana, and S. A. Salawu, “Major limb amputation in Ibadan,” African Journal of Medicine and Medical Sciences, vol. 31, no. 4, pp. 333–336, 2002.
[14]
Federal Republic of Nigeria, “Provisional results of the main findings of 2006 census,” Official Gazette, vol. 94, no. 4, Government notice No. 3, B52, Lagos, Federal Republic of Nigeria, 2007.
[15]
A. O. Ogbera, S. Chinenye, A. Onyekwere, and O. Fasanmade, “Prognostic indices of diabetes mortality,” Ethnicity and Disease, vol. 17, no. 4, pp. 721–725, 2007.
[16]
A. A. Otu, M. Akpan, and E. E. Effa, “Prevalence of diabetes mellitus in cross river state Nigeria,” Report, Cross River State Ministry of Health, 2012.
[17]
O. E. Enang, O. E. Essien, H. Okpara, O. A. Fasanmade, and A. E. Ohwovoriole, Prevalence and risk factors of dysglycaemia in Calabar, South East Nigeria [dissertation], National Postgraduate Medical College of Nigeria, 2012.
[18]
S. K. Shahi, A. Kumar, S. Kumar, et al., “Prevalence of diabetic foot ulcer and associated risk factors in diabetic patients from North India,” The Journal of Diabetic Foot Complications, vol. 4, no. 3, pp. 83–91, 2012.
[19]
S. Kumar, H. A. Ashe, L. N. Parnell et al., “The prevalence of foot ulceration and its correlates in Type 2 diabetic patients: a population-based study,” Diabetic Medicine, vol. 11, no. 5, pp. 480–484, 1994.
[20]
Yorkshire and Humber Public Health Observatory, “APHO Diabetes Prevalence Model: Key Findings for England,” Yorkshire and Humber Public Health Observatory, 2013, http://www.yhpho.org.uk/resource/view.aspx?RID=81124.
[21]
A. O. Ogbera, O. Fasanmade, A. E. Ohwovoriole, and O. Adediran, “An assessment of the disease burden of foot ulcers in patients with diabetes mellitus attending a Teaching Hospital in Lagos, Nigeria,” International Journal of Lower Extremity Wounds, vol. 5, no. 4, pp. 244–249, 2006.
[22]
“Issues in the New Poverty Report,” This Day Live Newspaper 21, 2013, http://www.thisdaylive.com/articles/issues-in-the-new-poverty-report/137011/.
[23]
A. D. McInnes, “Diabetic foot disease in the United Kingdom: about time to put feet first,” Journal of Foot and Ankle Research, vol. 5, article 26, 2012.
[24]
A. E. Edo and A. Eregie, “Bacteriology of diabetic foot ulcers in Benin City, Nigeria,” Mera: Diabetes International, 21–23, 2007.
[25]
O. O. Okunola, P. O. Akinwusi, B. A. Kolawole, and K. S. Oluwadiya, “Diabetic foot ulcer in a Tropical setting: presentation and outcome,” Nigerian Endocrine Practice, vol. 6, no. 1, pp. 10–14, 2012.
[26]
M. Zubair, A. Malik, and J. Ahmad, “Clinico-bacteriology and risk factors for the diabetic foot infection with multidrug resistant microorganisms in north India,” Biology and Medicine, vol. 2, no. 4, pp. 22–34, 2010.
[27]
F. A. Orji, N. C. Nwachukwu, and E. C. Udora, “Bacteriological evaluation of diabetic ulcers in Nigeria,” African Journal of Diabetes Medicine, vol. 15, no. 11, pp. 19–21, 2009.
[28]
A. Abdulrazak, Z. Ibrahim Bitar, A. Ayesh Al-Shamali, and L. Ahmed Mobasher, “Bacteriological study of diabetic foot infections,” Journal of Diabetes and Its Complications, vol. 19, no. 3, pp. 138–141, 2005.
[29]
A. T. Onajole and A. O. Bamgbala, “Socio demographic characteristics of drug misuse in a Polytechnic in Lagos, Nigeria,” Nigerian Journal of Health and Biomedical Sciences, vol. 3, no. 1, pp. 40–43, 2004.
[30]
C. O. Omolase, O. E. Adeleke, A. O. Afolabi, and O. T. Afolabi, “Self medication amongst general outpatients in a Nigerian community hospital,” Annals of Ibadan Postgraduate Medicine, vol. 5, no. 2, pp. 64–67, 2007.
[31]
A. Z. M. Saad, T. L. Khoo, and A. S. Halim, “Wound bed preparation for chronic diabetic foot ulcers,” ISRN Endocrinology, vol. 2013, Article ID 608313, 9 pages, 2013.
[32]
M. Tomic-Canic and H. Brem, “Gene array technology and pathogenesis of chronic wounds,” American Journal of Surgery, vol. 188, no. 1, pp. 67–72, 2004.
[33]
M. P. Khanolkar, S. C. Bain, and J. W. Stephens, “The diabetic foot,” QJM, vol. 101, no. 9, pp. 685–695, 2008.
[34]
S. A. Jayasinghe, I. Atukorala, B. Gunethilleke, V. Siriwardena, S. C. Herath, and K. De Abrew, “Is walking barefoot a risk factor for diabetic foot disease in developing countries?” Rural and Remote Health, vol. 7, no. 2, p. 692, 2007.
