Risk factors for lower extremity amputation amongst adult diabetic patients seen at Mulago Hospital.

Abstract

Background There is an increasing burden of diabetes and its complications worldwide. Many of these, especially Lower Extremity Amputation (LEA) are so debilitating and costly. LEAs are a preventable health burden and knowledge on their risk factors is necessary for designing and implementing appropriate and cost effective strategies. However, there is no sufficient information available on the risk factors for diabetes related lower extremity amputation in our environment. Objectives The objective of the study was to determine the risk factors associated with Lower Extremity Amputation in adult diabetic patients seen at Mulago hospital. Methods An unmatched case control study was conducted between August 2013 and January 2014 amongst 128 adult diabetic patients seen at Mulago Hospital. Cases were 45 adult diabetic patients in whom a decision to carry out a LEA had been made by an orthopedic surgeon during the study period and controls were 83 adult diabetic patients at Mulago hospital selected from those with no indication for amputation during the study period. Measurements included; socio demographic variables, type and duration of Diabetes Mellitus, history of Diabetic ulcer, blood pressure, BMI, level of Glycosylated heamoglobin (HbA1c), peripheral neuropathy and lipid profile. Results Significant risk factors for lower limb amputation were a high level of HbA1c (adjusted OR: 5.60; CI: 1.427-21.992) and history of diabetic foot ulcer (adjusted OR: 6.10; CI: 0.879-9.716). Diabetic patients with a duration of disease more than 10 years and peripheral neuropathy also had increased but not statistically significant risk association with LEA (adjusted OR: 2.92; CI: 0.879-9.716 and adjusted OR: 3.02; CI: 0.848-10.802 respectively). Age and sex differences did not significantly influence the risk for amputation in this study (OR: 1.82 (0.538-6.136) P.value 0.335for age category 40-59years, OR: 3.65 (1.051-12.685) P.value 0.041* for those 60 years and above and OR: 0.756 (0.357-1.602) P.value 0.466 for male sex). Conclusions Those most likely to undergo LEA amongst adult diabetic patients at Mulago hospital were those with poor glyceamic control and history of diabetic foot ulcer. Such patients had an almost 10- fold increase in the risk for amputation considering adjusted odds ratios. They were also likely to have peripheral neuropathy and diabetes for more than 10 years. Such patients considered to be at high risk of LEA should be closely monitored and aggressively treated to help avert the unwanted possibility of LEA in the Mulago hospital health care system.