Clinical Pattern of Diabetic Foot Infections and their Management

Mohana Priya, T (2008) Clinical Pattern of Diabetic Foot Infections and their Management. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: In the years between 1958 and 1993, the number of people diagnosed with diabetes multiplied five – fold. In 1994, 135 million patients world – wide were living with Diabetes mellitus. By the year 2025, it is estimated that this figure would increase to more than 300 million. Diabetes mellitus is a chronic metabolic disorder, predominantly of carbohydrates, which has hereditary and environmental risk factors. According to the criteria of WHO and the ADA (American Diabetes Association) of 1997, a diagnosis can be established on the basis of fasting plasma glucose levels of : 1. 7.8 mmol/L (126 mg/dl) or above (with or without the presence of the classic signs such as polydipsia, tiredness, unexplained weight loss or pruritus). 2. 11.1 mmol/L (200mg/dl) and above measured at random and coexisting with the disease symptoms mentioned previously. 3. 11.1 mmol/L (200mg / dl) measured two hours after a standardized oral glucose tolerance test. AIM AND OBJECTIVES: With the projected 14% prevalence rate of Diabetes Mellitus in Indian population and about 5 – 10% of them developing foot infections and associated foot lesions, it becomes imminent for the health care system to put in practice a logistically feasible management strategy for Diabetic foot in Government Hospitals. This becomes important in view of the fact that over 80% of general population in India approach only Government Hospitals for their health care requirements. With this aim in mind, the present study was planned and conducted. The objectives of the project are: 1. To study the clinical pattern of foot infections in Diabetic patients. 2. To study the effect of Glycaemic status in controlling infection. 3. To analyze the risk factors leading to complications in Diabetic Foot-infections 4. To study the outcome of the treatment modalities and suggest a patient friendly hospital management strategy for Diabetic foot MATERIALS AND METHODS: Materials: This is a prospective study of consecutive Diabetic patients with foot complications admitted in the surgical wards of Government Royapettah Hospital during the period of August 2005 – August 2007. A total of 200 cases were analysed during this period. Methods: Detailed history and thorough clinical examination was done in all cases. Documentation was done using a stratified proforma which included demographic data of the patients studied; all the details of investigations carried out and the types of management and treatments provided to the patients enrolled in the study. For all patients, hematological, biochemical, microbiological and radiological investigations were carried out as enumerated in the proforma using standard procedures. Blood sugar and Renal parameters were performed at the time of admission. Fasting, Post prandial, Pre dinner and Post dinner Blood sugar was done on the next day and repeated according to Blood sugar levels. Urine analysis including urine acetone was done. X-ray of local part, Ultrasonogram Abdomen and Hand held Doppler study of both limbs was done. As Duplex scan was not available in our hospital, they were done at Government General Hospital for patients who were suspected to have Arteriopathy. Appropriate treatment was provided according to the Grade of Diabetic foot lesions. This included infection control with antibiotics only ; Slough excision with antibiotics ; slough excision with split skin graft or flap; fasciotomy; incision and drainage or amputation at appropriate level. All these procedures were carried out as described. Health Education was given to patients regarding foot care and were followed up regularly every 2 weeks. SUMMARY: 200 consecutive Diabetic patients with foot complications admitted in Government Royapettah Hospital, Chennai during August 2005 to August 2007 where characterized for demographic factors, investigatory profiles, clinical presentations as per International norms; and underlying risk factors. Effective management strategies were planned and executed with the sole aim of achieving diabetes control and salvaging the diabetic foot with significant success. CONCLUSIONS: 1. 76.5% of the diabetic foot cases were in the 40 – 69 years age groups, while maximum cases in men was seen in 50 – 59 years age group and the same in women was in the 60 – 69 years age group. 2. 55% of the diabetic foot patients were poor and 60% were walking bare-footed and hence prone for trauma and ulcer development. 3. 52.5% of the cases had high blood sugar levels of 201 – 300 mg/dl at the time of admission and 21.5% had Keto-acidosis. 4. 91% of the patients were bacteriologically positive for infection either with single organism (73%) or with multiple organisms (18%). 5. The patients with diabetic foot presented with abscess (2%); cellulitis (23%); ulcer (55%) and gangrene (20%). While 110/200 (55%) cases presented with diabetic ulcers, 85.4% of these cases presented with Grade II ulcers as per Wagner’s Classification. 6. Anatomical Bony deformities, arteriopathy, neuropathy, retinopathy, obesity were the common risk factors in the study group leading to complications in diabetic foot. 7. In this study, 165/200 (82.5%) could be limb-salvaged with antibiotics alone and/or slough excision in various stages and fasciotomy. 8. 35 cases (17.5%) have to undergo different levels of amputation within which majority of them (22/35) were only toe Disarticulation. 9. The present study concludes that adequate glycemic control, appropriate antibiotic therapy and prompt slough excision–mediated debridement therapy can be the successful limb salvage programme in nearly 93.5% of the diabetic foot cases.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Diabetic Foot Infections ; Clinical Pattern ; Management.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 05 Jun 2018 17:40
Last Modified: 06 Jun 2018 03:13

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