Record review of the management of patients admitted for diabetic foot complications

Abstract

The human burden of diabetes is a consequence of devastating chronic complications. Common complications of diabetes are micro vascular disease (nephropathy, retinopathy and neuropathy) and increased risk of macro vascular disease (stroke, heart attack and peripheral vascular disease). With the onset of neuropathy, many diabetic people are at risk of developing diabetic foot. Foot complications, especially foot ulcers, constitute a major public health problem for diabetes patients in sub-Saharan Africa and are an important cause of prolonged hospital admission and death in patients from this part of the continent Aim The descriptive study aims to determine clinical features, foot-related and cardiovascular risk factors, management, and clinical outcomes of patients admitted with diabetic foot in general surgery wards of the Pretoria Academic Hospital. Methods and Materials A retrospective audit of the surgical ward register and patient files was conducted for a period of two years – 2005 to 2006. All those patients who were admitted for the first time with diabetic foot complication were included in the analysis. Results: Patients admitted with diabetic foot complications were 2.52 % and 4.58% out of the total admissions in female and in male surgical wards respectively. A total of 81 records were identified, reviewed and analysed. Results of the study showed that 54.3% (n=44) were females and the mean age of the sample was 61.44 (+ 12.9) years. Of the total number of patients 18.5 % (n 15) were smokers, 29.6% (n=24) had never smoked, and 37% (n=30) were ex-smokers. Peripheral pulses were examined in 85% and in 18% of cases; both pulses were absent in the affected foot. Assessment of neurological status using Semmes Weinstein 5.07 monofilament was not done or other non-specific methods were used. Ulcers were assessed in 44% of cases but the documentation of size of site and appearance was poor. No classification system or grading of ulcers was used. Regarding cardiovascular risk; 67% had HT and were taking treatment. Lipid values were measured in less than 10% of subjects. Renal function was measured in 94%. Of all admissions 48% had below knee and 18.5 % above knee amputations. Approximately 33% of patients were readmitted, of which 23% of admissions were for problems in the same foot. On discharge 43% were prescribed ACE inhibitors, 33% aspirin and only 12% statins. Very few ( n=03) patients reached the Diabetic Clinic of Pretoria Academic Hospital for follow up in the three months following discharge and none in reached the Kalafong Diabetic Clinic. Conclusions This study found that there was no standardised protocol for ulcer grading, detection of neuropathy or evaluation of cardiovascular risk. Long-term care of these patients could possibly be improved by involving other disciplines during the admission of patients with diabetic foot.