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|Title: ||Incidence and determinants of diabetesrelated lower limb amputations in Ghana, 2010–2015- a retrospective cohort study|
|Authors: ||Sarfo-Kantanka, Osei|
Sarfo, Fred Stephen
Mbanya, Jean Claude
Lower limb amputation
|Issue Date: ||2019|
|Publisher: ||BMC Endocrine Disorders|
|Citation: ||BMC Endocrine Disorders (2019) 19:27, https://doi.org/10.1186/s12902-019-0353-8|
|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.|
|Description: ||An article published in BMC Endocrine Disorders (2019) 19:27
|Appears in Collections:||College of Health Sciences|
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