Sarfo-Kantanka Osei, Sarfo Fred Stephen, Kyei Ishmael, Agyemang Charles, Mbanya Jean Claude
Komfo Anokye Teaching Hospital, Endocrine and Diabetes Unit, P.O Box 1934, Kumasi, Ghana.
Department of Medicine, Komfo Anokye Teaching Hospital/ School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
BMC Endocr Disord. 2019 Mar 1;19(1):27. doi: 10.1186/s12902-019-0353-8.
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.
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.
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).
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.
糖尿病相关的下肢截肢（LLA）与显著的发病率和死亡率相关。尽管在过去二十年中，大多数高收入国家的发病率有所下降，但中低收入国家（LMIC）的情况，尤其是撒哈拉以南非洲（SSA）国家的情况尚不清楚。我们已经确定了加纳糖尿病相关LLA的发病率及其决定因素。
这是一项基于三级医疗的回顾性队列研究，研究对象为2010年1月1日至2015年12月31日在加纳Komfo Anokye教学医院糖尿病诊所登记的患者，中位随访时间为4.2年。记录了基线时的人口统计学特征和临床变量。主要结局是研究期间每年新发生的糖尿病相关LLA。采用Cox比例风险回归模型描述糖尿病相关LLA的关联。
该队列的平均入组年龄为55.9±14.6岁，女性占多数（62.1%）。糖尿病相关LLA的平均发病率为每1000人年2.4例（95%CI：1.84-5.61）：从2010年每1000人年0.6%（95%CI：0.21-2.21）增加到2015年每1000人年10.9%（95%CI：6.22-12.44）。糖尿病相关LLA与入组年龄增加相关（年龄每增加10岁：HR：1.11，CI：1.06-1.22，p<0.001）、男性（HR：3.50，CI：2.88-5.23，p<0.01）、2型糖尿病（HR 3.21，CI：2.58-10.6，p<0.001）、高体重指数（HR：3.2，CI：2.51-7.25，p<0.001）、血糖控制不佳（糖化血红蛋白每增加1%，HR：1.11，CI：1.05-1.25，p=0.03）、高血压（HR：1.14，CI：1.12-3.21，p<0.001）、周围感觉神经病变（HR：6.56，CI：6.21-8.52，p<0.001）和周围血管疾病（HR：7.73，CI：4.39-9.53，p<0.001）。
该研究证实了加纳糖尿病相关LLA的高发病率。中低收入国家应引入旨在解决全身性和患者层面阻碍糖尿病患者良好血管危险因素控制及适当足部护理的障碍的干预措施，以遏制LLA发病率不断上升的趋势。
