Reducing diabetes-related major limb amputations: A plea for a multidisciplinary team approach

Background: Diabetic foot is a challenging complication of diabetes mellitus, affecting a significant number of diabetic patients and often resulting in amputations especially in resource-poor nations. Patients and Methods: A 4-year retrospective review of clinical records of patients with diabetic foot lesions (DFLs) treated at Ahmadu Bello University Teaching Hospital, Zaria. Results: One hundred and thirty-eight patients were admitted with DFLs, but only 109 patients had complete medical records available for review. Nine patients had bilateral lesions at presentation. Seventy-three (61.9%) were male and 45 (38.1%) were female. Three (2.6%) were young adults ( 65 years). Fifty-two (44.0%) of the lesions were admitted through the diabetic clinic while 66 (56.0%) presented to the emergency room. Wagner Grade IV and V lesions constitute the majority (68.7%). The mean duration of the lesions at presentation was 6 weeks while the mean interval between first review by an endocrinologist and first surgical review was 17 days for those admitted through the diabetic clinic. Seventy-seven had surgical interventions, 30 of which were major amputations. The mortality rate was 14.6%. Conclusion: Diabetes-related foot lesions pose a great challenge in developing countries, with a significant number of the patients undergoing major amputation, an incapacitating outcome largely contributed to by late presentation and poor quality of diabetic foot care. With the impact being made by public health enlightenment programs on diabetes complications, a multidisciplinary team care approach from the outset goes a long way in reducing major amputations in these patients.