Aim

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.

Methods

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.

Results

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).

Conclusions

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.

中文翻译：

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斐济 2 型糖尿病 (T2DM) 患者与指数下肢截肢 (LEA) 相关的模式和风险因素

目标

描述指数（有史以来第一次）下肢截肢 (LEA) 的模式，并确定与斐济 2 型糖尿病 (T2DM) 患者发生这种情况相关的因素。

方法

这项横断面研究遵循 STROBE 检查表，用于在 2011 年至 2015 年期间在斐济殖民战争纪念医院 (CWMH) 经历指数 LEA 的 T2DM 患者中进行观察研究。从患者文件夹中提取人口统计学和临床​​变量。单变量和多变量逻辑回归用于确定与主要 LEA 相关的因素。p 值 < 0.05 被认为是显着的。

结果

共有 649 名研究参与者接受了研究，平均截肢年龄为 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%) 和土著斐济人 (71.8%) 中更为常见。三分之一的指数 LEA (33%) 是大截肢。与重大 LEA 发生相关的因素是随机血糖 (RBS) 水平差 (OR = 1.68, 95% CI: 1.01, 2.81)、足中部病变 (OR = 9.38 95% CI: 4.95, 19.52)、败血症 (OR = 2.42 , 95% CI: 1.28, 4.57)、低血红蛋白水平 (OR = 0.78 95% CI: 0.72, 0.86) 和高血压病史 (OR = 0.58, 95% CI: 0.40, 0. 84)。

结论

结果表明，患有足部感染的糖尿病患者接受三级护理的时间较晚。我们的研究结果还表明迫切需要加强对糖尿病和糖尿病 LEA 的初级保健干预和监测。