Factors Leading to Delayed Presentation of Patients with Diabetic Foot Sepsis at Regional Hospitals in the Ekurhuleni Metropolitan Municipality of Gauteng Province
Mukendi, I.; Mundawarara, S.; Luvhengo, T.
South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie 55(2): 68
2017
ISSN/ISBN: 0038-2361 PMID: 28876679 Document Number: 692325
Nearly 50% of all diabetes-related admissions are due to diabetic foot problems and diabetes mellitus is the commonest cause for non-traumatic amputation of the lower limb. A prospective longitudinal observational study of all patients 18 years and older was conducted. Data collected included demographics, diabetic history and treatment type, comorbidities, prior treatment, clinical findings, treatment method and overall outcome. Data was entered into an Excel spreadsheet for analysis, and categorical data was expressed in percentages whereas continuous data in mean and 95% confidence interval. Incident risk ratio was calculated. Chi square and Student t-test were used when appropriate. Permission to conduct the study was received from HREC at Wits (M160759). 68 patients were studied of which 61.8% (42/68) were males. The average age for males and females was 58.9 and 63.9 years respectively. 90.5% of males and 96.2% of females were known diabetic and 51.5% were on oral hypoglycaemics. 47.1% had prior diabetic education, 36.8% had home haemoglucotest and compliance was good in 39.7%. 71.4% of males and 80.8% of females presented more than two weeks after onset of foot sepsis. Prior use of herbal medication was reported by 16.7% of males compared to 26.9% in females. 69.1% were seen at a clinic and 71.4% were treated with antibiotics before referral. 53.8% of females and 59.5% of males were amputated and mortality was 15.4% and 4.8% for females and male, respectively. Majority of patients presenting with diabetic foot sepsis are known with diabetes and are on oral hypoglycaemics. Trial of antibiotic and herbal therapy is attempted for most patients before they are referred. More than 50% end with amputation and mortality is three times higher in females.