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. 2019 Mar 1;19(1):27.
doi: 10.1186/s12902-019-0353-8.

Incidence and determinants of diabetes-related lower limb amputations in Ghana, 2010-2015- a retrospective cohort study

Osei Sarfo-Kantanka  1 , Fred Stephen Sarfo  2   3 , Ishmael Kyei  2 , Charles Agyemang  4 , Jean Claude Mbanya  5
Affiliations

Incidence and determinants of diabetes-related lower limb amputations in Ghana, 2010-2015- a retrospective cohort study

Osei Sarfo-Kantanka et al. BMC Endocr Disord. .

Abstract

Background: Diabetes-related lower limb amputations (LLA) are associated with significant morbidity and mortality. Although the incidence has decreased over the past two decades in most High-Income Countries, the situation in Low-Middle Income Countries (LMIC), especially those in sub-Saharan Africa (SSA) is not clear. We have determined the incidence and determinants of diabetes-related LLA in Ghana.

Methods: This was a tertiary-care-based retrospective cohort study involving patients enrolled in the diabetes clinic of Komfo Anokye Teaching Hospital, Ghana from 1st January 2010 to 31st December 2015 after a median follow-up of 4.2 years. Demographic characteristics and clinical variables at baseline were recorded. The primary outcome was new diabetes-related LLA in each year under study. Cox proportional hazard regression models were used to describe the associations of diabetes-related LLA.

Results: The mean age at enrolment for the cohort was 55.9 ± 14.6 years, with a female preponderance (62.1%). The average incidence rate of diabetes-related LLA was 2.4 (95% CI:1.84-5.61) per 1000 follow-up years: increasing from 0.6% (95% CI:0.21-2.21) per 1000 follow up years in 2010 to 10.9% (95% CI:6.22-12.44) per 1000 follow-up years in 2015. Diabetes-related LLA was associated with increased age at enrollment (for every 10 year increase in age: HR: 1.11, CI: 1.06-1.22, p < 0.001), male gender (HR: 3.50, CI:2.88-5.23, p < 0.01), type 2 diabetes (HR 3.21, CI: 2.58-10.6, p < 0.001), high Body Mass Index (HR: 3.2, CI: 2.51-7.25 p < 0.001), poor glycemic control (for a percent increase in HbA1c, HR:1.11, CI:1.05-1.25, p = 0.03), hypertension (HR:1.14, CI:1.12-3.21 p < 0.001), peripheral sensory neuropathy (HR:6.56 CI:6.21-8.52 p < 0.001) and peripheral vascular disease (HR: 7.73 CI: 4.39-9.53, p < 0.001).

Conclusion: The study confirms a high incidence of diabetes related-LLA in Ghana. Interventions aimed at addressing systemic and patient-level barriers to good vascular risk factor control and proper foot care for diabetics should be introduced in LMICs to stem the tide of the increasing incidence of LLA.

Keywords: Diabetes; Ghana; Lower limb amputation.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Committee on Human Research Publication and Ethics of the School of Medical Sciences, Kwame Nkrumah University of Science and Technology, and the Komfo Anokye Teaching Hospital, Kumasi. We anonymised patient’s records/information before analysis.

Consent for publication

Not applicable on request.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Diabetes-related lower limb amputation in Central Ghana
Fig. 2
Fig. 2
Causes of diabetes-related lower limb amputations in central Ghana
See this image and copyright information in PMC

References

    1. NCD Risk Factor Collaboration (NCD-RisC) Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016;387:1513–1530. doi: 10.1016/S0140-6736(16)00618-8. - DOI - PMC - PubMed
    1. Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modelling of incidence, mortality, and prediabetes prevalence. Popul Health Metrics. 2010;8:29. doi: 10.1186/1478-7954-8-29. - DOI - PMC - PubMed
    1. Peer N, Kengne A-P, Motala AA, Mbanya JC. Diabetes in the Africa region: an update. Diabetes Res Clin Pract. 2014;103:197–205. doi: 10.1016/j.diabres.2013.11.006. - DOI - PubMed
    1. Zhang P, Zhang X, Brown J, Vistisen D, Sicree R, Shaw J, et al. Global healthcare expenditure on diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:293–301. doi: 10.1016/j.diabres.2010.01.026. - DOI - PubMed
    1. Blay SL, Fillenbaum GG, Marinho V, Andreoli SB, Gastal FL. Increased health burden associated with older Brazilians with diabetes. J Affect Disord. 2011;134:77–84. doi: 10.1016/j.jad.2011.05.012.. - DOI - PMC - PubMed