Risk Factors for Amputation in Patients with Diabetic Foot Diseases in Sokoto, Nigeria

Abstract

Background: Diabetic foot disease is a foot that exhibits any pathology that results directly from diabetic mellitus or any long-term chronic complication of diabetes mellitus. The aim of the study was to determine the risk factors and indications for amputations in diabetics and to correlate these risks with mortality in our environment. Patients and methods: An audit of consecutive patients who were referred and had amputation as a result of diabetic foot diseases in a tertiary institution in Sokoto, northwest Nigeria over a 2-year period was done. Parameters studied using a predetermined protocol included the bio-data, socioeconomic status, vascular status, Meggit-Wagner grading status, indications for amputation and outcome. Results: There were nineteen amputations done in 19 patients with age range of 45 to 75 years and a mean age of 57.94 ± 8.92. There were more females (68%) than males (32%) giving a M:F ratio of 1:2. Forty-one percent of patients were housewives and 89.5% were of middle socioeconomic status. Seventy-three percent of the patients had no formal education while 31.6% has had diabetes for between 6 and 10 years. All the patients had comorbidity and 78.9% were Wagner's grade V. Ascending cellulitis and sepsis (68.4%) was the commonest indication for amputation. Trans femoral amputation was carried out in 47.4% and 21.1% had reamputation. A mortality rate of 15.8% was recorded and 52.6% defaulted from follow-up. There was no correlation between the risk factors and outcome in these patients (p > 0.05). Conclusions: Amputation was commonly done in the female diabetic housewife with no formal education. Educating these patients, improving their socioeconomic status will help them modify behaviours and identify foot at risk and complications.