Patterns and risk factors associated with index Lower Extremity Amputations (LEA) among Type 2 Diabetes Mellitus (T2DM) patients in Fiji. Issue 6 (December 2021)

• Record Type: Journal Article
• Authors: Khan, Sabiha; Mohammadnezhad, Masoud; Ratu, Anaseini; Ghosh, Anamica; Ali, Wahed; Nand, Devina; Mangum, Tamara
• Is Part Of: Primary care diabetes. Volume 15:Issue 6(2021)
• Page Start: 1012
• Page End: 1018
• Publication Date: 2021-12
• Subjects: Type 2 diabetes -- Lower extremity amputations -- Determinants -- Fiji; Diabetes -- Periodicals; 616.462
• DOI: 10.1016/j.pcd.2021.07.007
• Languages: English
• ISSNs: 1751-9918

Abstract

Highlights: T2DM patients with different ethnicities experience different LEAs. Hypertension is most common co-morbidity among T2DM patients with Major LEA. Patients with Major LEAs have higher death than patients with Minor LEAs. Different factors are associated with occurrence of Major LEA among T2DM patients. Abstract: Aim: To describe patterns of index (first ever) Lower Extremity Amputations (LEA) and to determine factors associated with their occurrence amongst Type 2 Diabetes Mellitus (T2DM) patients in Fiji. Methods: This cross-sectional study was conducted that adheres to the STROBE check lists for observational research among T2DM patients who experienced index LEA at the Colonial War Memorial Hospital (CWMH) in Fiji between 2011 and 2015. Demographic and clinical variables were extracted from patient folders. Univariate and multivariate logistic regression were used to determine factors associated with Major LEA. A p-value < 0.05 was considered significant. Results: A total of 649 study participants were studied with the average age of index amputation was 58.4 years (±9.6 years, range 30–91 years). The average duration of T2DM was 9.5 ± 5.7 years. LEAs were more common amongst males (55%) and indigenous Fijians (71.8%). One-third of index LEA (33%) were major amputations. Factors associated with occurrence of Major LEA were poor Random Blood Sugar (RBS) levels (OR = 1.68, 95% CI: 1.01, 2.81), midfoot lesion (OR = 9.38 95% CI: 4.95, 19.52), septicaemia (OR = 2.42, 95% CI: 1.28, 4.57), low haemoglobin level (OR = 0.78 95% CI: 0.72, 0.86), and history of hypertension (OR = 0.58, 95% CI: 0.40, 0. 84). Conclusions: Results indicate that diabetic patients with foot infections present late to tertiary level care. Our findings also show an urgent need to strengthen primary care interventions and surveillance of both diabetes and diabetic LEA.