Abstract
ABSTRACT Background: Diabetic foot remains a challenge in most low-middle-income countries (LMICs). A severe deficit in data exists on them in sub-Saharan Africa (SSA). Up-to-date data on the longitudinal trajectories and determinants can provide a benchmark for reducing diabetic foot complications in SSA. Objective: The primary objective of this study was to estimate trends in the incidence of diabetic foot and determine predictors in an adult Ghanaian diabetes cohort. Design: The study is a retrospective longitudinal study over a 12 year period. Methods: We applied Poisson regression analysis and Cox proportional hazard models to demographic and clinical information obtained from patients who enrolled in a diabetes specialist clinic in Ghana from 2005 to 2016 to identify longitudinal trends in incidence and predictors of diabetic foot. Results: The study comprised 7383 patients (63.8% female, mean follow-up duration: 8.6 years). The mean incidence of foot disorders was 8.39% (5.27% males and 3.12% females). An increase in the incidence of diabetic foot ranging from 3.25% in 2005 to 12.57% in 2016, p < 0.001, was determined. Diabetic foot, with adjusted hazard ratio (HR; 95% confidence interval (CI)), was predicted by disease duration, that is, for every 5-year increase in diabetes duration: 2.56 (1.41–3.06); male gender: 3.51 (1.41–3.06); increased body mass index (BMI), that is, for every 5 kg/m2: 3.20 (2.51–7.52); poor glycaemic control, that is, for every percentage increase in HbA1c: 1.11 (1.05–2.25), hypertension: 1.14 (1.12–3.21); nephropathy: 1.15 (1.12–3.21); and previous foot disorders: 3.24 (2.12–7.21). Conclusions: We have found a trend towards an increased incidence of diabetic foot in an outpatient tertiary diabetes setting in Ghana. Systemic and individual-level factors aimed at preventive foot screening as well as vascular risk factor control should be intensified in diabetic patients in Ghana and other LMICs. Abbreviations: BMI: Body Mass Index, BP: Blood Pressure, CI: Confidence Interval, HR: Hazard Ratio, HbA1c: Glycated Hemoglobin, PAD: Peripheral Arterial Disease, NCDs: Non Communicable Disease, SSA: Sub Saharan Africa.
Highlights
Of the many complications of diabetes, foot disorders represent the commonest, with a lifetime risk of 25% [1]
A high incidence of diabetic foot, with incidence usually upwards of 10% has been recorded in low-middleincome countries (LMICs), those in subSaharan Africa (SSA) [11,12,13,14]
During the early period under review, that is, between 2005 and 2006, the incidence rate of the diabetic foot was comparable among males and females; the period between 2007 and 2012 was characterised by a significantly higher incidence rate in males compared to females
Summary
Of the many complications of diabetes, foot disorders represent the commonest, with a lifetime risk of 25% [1]. Diabetic foot defined as the foot of a diabetic patient with ulceration, infection and destruction of the deep tissues, associated with neurological abnormalities and various degrees of peripheral vascular disease (PVD) in the lower limb [1] It is associated with both short- and long-term increase in morbidity, mortality and lower limb amputation [2,3]. Among high-income countries, an evident reduction in the incidence of the diabetic foot has been recorded over the past three decades [5,6,7,8]. These achievements were mostly through a campaign of increased screening, widespread adoption of multidisciplinary foot clinics and stringent vascular risk factor management [9,10]. Design: The study is a retrospective longitudinal study over a 12 year period
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call