In India, more people with diabetes are having their toes or even feet removed due to sores than the former estimates, a study by Christian Medical College, Vellore, has found. It also found that after one amputation, the chance of having another in the future is three times higher.
According to the study published in the peer-reviewed medical journal Science Direct, foot sores caused by diabetes in the Indian population are bigger when they first show up compared to what is usually seen around the world. The study emphasized that underestimates of the burden of recurrence and mortality are due to the limited follow-ups.
“Patients with diabetic foot ulcers (DFU) in India incur amputations at rates higher than conventionally described. With the previous amputation, subsequent amputation risk triples,” said the study, adding that the 10-year mortality hovers between 25% and 30%.
The most common cause of death is heart-related issues, followed by sepsis infections. Over an average follow-up period of about 6.08 years, the mortality rates are higher for those who had amputations or who had to remove the parts compared to those whose ulcers healed.
WHAT DO THE FINDINGS SHOW?
The study has been spearheaded by a team from the Department of Endocrinology, Diabetes, and Metabolism at Christian Medical College, Vellore.
In the study, of the 200 patients, more than 60% were men and the average age was 62 years old –ranging from 40 to 86 years. On an average, they had been living with diabetes for 15 years – ranging from 2 to 43 years. The wounds took about three months to heal (ranging from 0.23 to 37.62 months) completely.
About 43.4% of patients needed amputation for their current ulcer, the study found and added that among them, 42.4% experienced a recurrence of the ulcer, with most of them – more than 66 % – happening on the same side as the previous one. It proved that having an amputation before increased the risk of needing another one in the future.
The study also found that for those who had an amputation, the average time before the ulcer came back was about 4.23 years, compared to 9.61 years for those whose ulcers healed without amputation.
WHAT EXPERTS SAY
According to Dr Anoop Misra, chairman, Fortis C-DOC Hospital for Diabetes and Allied Sciences, “Foot problems in diabetes are often neglected. Once foot infections occur, chronicity is common.”
Misra, who is also Director, National Diabetes Obesity and Cholesterol Foundation (NDOC), added that “It is important to adhere to good control of diabetes, blood pressure and cholesterol, wear good footwear, avoid barefoot walking and pay prompt attention to any injury or wound in foot.”
One of the authors of the study, Felix Jebasingh, professor in the Department of Endocrinology, Diabetes and Metabolism, CMC, Vellore, told News18 that their study, conducted by the team from the integrated diabetes foot clinic, reveals that patients with diabetes mellitus typically present with larger foot ulcers initially.
“The median time to complete healing was three months, though, for some, it extended up to three years. This was achieved after prescribing appropriate customised footwear and regular follow-up and foot care education.”
Felix added that early diagnosis and the use of appropriate, specially modified footwear are crucial for the rapid healing of ulcers and for preventing both initial occurrences and recurrences. “This approach markedly reduces premature mortality among these patients. Moreover, educating patients about proper foot care and the importance of suitable footwear is a critical component of our patient education efforts.”
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