Khan Sabiha, Mohammadnezhad Masoud, Ratu Anaseini, Ghosh Anamica, Ali Wahed, Nand Devina, Mangum Tamara
School of Public Health and Primary Care, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.
School of Public Health and Primary Care, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.
Prim Care Diabetes. 2021 Dec;15(6):1012-1018. doi: 10.1016/j.pcd.2021.07.007. Epub 2021 Jul 17.
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.
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.
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).
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.
描述首次下肢截肢（LEA）的模式，并确定斐济2型糖尿病（T2DM）患者中与下肢截肢发生相关的因素。
本横断面研究遵循观察性研究的STROBE清单，研究对象为2011年至2015年期间在斐济殖民地战争纪念医院（CWMH）接受首次LEA的T2DM患者。从患者病历中提取人口统计学和临床变量。采用单因素和多因素逻辑回归确定与大截肢相关的因素。p值<0.05被认为具有统计学意义。
共研究了649名参与者，首次截肢的平均年龄为58.4岁（±9.6岁，范围30 - 91岁）。T2DM的平均病程为9.5±5.7年。LEA在男性（55%）和斐济原住民（71.8%）中更为常见。三分之一的首次LEA（33%）为大截肢。与大截肢发生相关的因素包括随机血糖（RBS）水平差（OR = 1.68，95%CI：1.01，2.81）、中足病变（OR = 9.38，95%CI：4.95，19.52）、败血症（OR = 2.42，95%CI：1.28，4.57）、血红蛋白水平低（OR = 0.78，95%CI：0.72，0.86）和高血压病史（OR = 0.58，95%CI：0.40，0.84）。
结果表明，足部感染的糖尿病患者到三级医疗机构就诊较晚。我们的研究结果还表明，迫切需要加强初级保健干预以及对糖尿病和糖尿病性LEA的监测。
