Bahati Rickson, Kitua Daniel, Selestine Leonard, Mwanga Ally, Urio Miriam, Mchele Godfrey, Antanamsu David
Department of Surgery, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.
Department of Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania.
BMC Endocr Disord. 2025 Mar 20;25(1):76. doi: 10.1186/s12902-024-01785-0.
Diabetic foot ulcers (DFUs) are prevalent among individuals with poorly controlled diabetes, and severe cases can result in increased morbidity and a poor quality of life. This study aimed to identify the factors that affect the severity of DFUs, offering insights into potential interventions that could enhance patient outcomes.
A prospective cross-sectional study was conducted from August 2023 to March 2024 at Muhimbili National Hospital in Tanzania, involving 177 consecutively selected patients with DFUs. The primary outcome variable was the severity of DFUs, which was assessed using the Meggitt-Wagner severity score. Both socio-demographic and clinical characteristics were evaluated to determine their association with the outcome variable using multivariate ordinal logistic regression analysis.
The median age of the study participants was 60 years (IQR = 52-68), with a male-to-female ratio of 2 to 1. Notably, Wagner grades 4 and 5 accounted for 57.6% of the participants. Factors associated with increased severity of DFUs included age over 60 years (aOR = 1.83, 95% CI 1.05-3.23, p = 0.035) and poor adherence to diabetes medications (aOR = 2.62, 95% CI 1.36-5.09, p = 0.004). Conversely, having health insurance coverage was linked to better outcomes (aOR = 0.51, 95% CI 0.27-0.96, p = 0.036).
The study highlights factors that can enhance comprehensive care for diabetic patients, especially elderly individuals. Key measures include implementing educational programs to encourage medication adherence, improving healthcare access, particularly for uninsured individuals, promoting insurance coverage, and making diabetes treatments more affordable.
糖尿病足溃疡（DFUs）在糖尿病控制不佳的个体中很常见，严重病例会导致发病率增加和生活质量下降。本研究旨在确定影响糖尿病足溃疡严重程度的因素，为可能改善患者预后的潜在干预措施提供见解。
2023年8月至2024年3月在坦桑尼亚的穆希姆比利国家医院进行了一项前瞻性横断面研究，纳入了177例连续入选的糖尿病足溃疡患者。主要结局变量是糖尿病足溃疡的严重程度，采用梅吉特 - 瓦格纳严重程度评分进行评估。使用多变量有序逻辑回归分析评估社会人口统计学和临床特征与结局变量之间的关联。
研究参与者的中位年龄为60岁（四分位间距 = 52 - 68），男女比例为2比1。值得注意的是，瓦格纳4级和5级占参与者的57.6%。与糖尿病足溃疡严重程度增加相关的因素包括60岁以上（调整后比值比 = 1.83，95%置信区间1.05 - 3.23，p = 0.035）和糖尿病药物治疗依从性差（调整后比值比 = 2.62，95%置信区间1.36 - 5.09，p = 0.004）。相反，拥有医疗保险与更好的结局相关（调整后比值比 = 0.51，95%置信区间0.27 - 0.96，p = 0.036）。
该研究强调了可加强糖尿病患者综合护理的因素，特别是老年患者。关键措施包括实施教育项目以鼓励药物治疗依从性，改善医疗服务可及性，特别是针对未参保个体，促进保险覆盖，并使糖尿病治疗更具可负担性。
