Author: Sharma V

Keywords: Diabetes, Foot sepsis, amputation

ABSTRACT
Maturity  onset  Diabetes  is  affecting  Fiji  and Pacific    in    epidemic    proportions.    Current information indicates the incidence of diabetes mellitus over the age of 40 years to be between 30 and 50 percent of the total population. Indigenous Fijians are at higher risk of developing diabetes, particularly   those   who   are   overweight   and with sedentary lifestyle, although no race with similar risk factors are immune to developing diabetes.  A high numbers of those who develop diabetes fail to successfully manage their sugar level, and eventually end up developing various complications, such as diabetes foot sepsis and amputations, diabetic keto-acidosis, and end stage kidney disease, Hospital data indicate the rate of diabetes related amputations to be around 300 every year. Management of Diabetes and its complications are responsible for taking up major share of health ministry’s resources. 

INTRODUCTION
Diabetes  Mellitus  and  its  complications  have grown to become one of the major health problems in Fiji. A diabetic is at risk from complications  of  neuropathy,   peripheral vascular diseases and impaired wound healing. These health complications cause circulation impairment, diminished skin sensation and poor wound healing, resulting in infection, ulceration, gangrene and consequently amputation.

The purpose of this paper is to reflect upon the patterns associated with diabetic foot sepsis.

MATERIALS AND METHOD
Data on diabetes and its complications leading to foot sepsis was obtained from the Statistics Unit, Ministry of Health based on various parameters. Available data  from  years 2001 and  2009 was analyzed.

RESULTS

           

diabetes fail to successfully manage their sugar level, and eventually end up developing various complications, such as diabetes foot sepsis and amputations, diabetic keto-acidosis, and end stage kidney disease, Hospital data indicate the rate of diabetes related amputations to be around 300 every year. Management of Diabetes and its complications are responsible for taking up major share of health ministry’s resources. 

In 2001 Type 1 and Type 2 diabetics were reported with foot sepsis. 67% of Type 1 diabetics were Fijian and 38% were Indian. While half the cases for Type 2 diabetics with foot sepsis were found to be Fijian, 39% Indians and 11% from other ethnic groups.

                     
In 2001 patients with Type 1 diabetes foot sepsis mostly found  over the  age of 50 while those with Type 2 diabetes associated with foot sepsis were mostly found over the age of 45. With the exception of just one case which was reported in a child less than 9 years of age.

In 2009 NIDDM patients with foot sepsis was commonly seen in patients over the age of 40 with the exception of 2 cases between the ages of 25-34. However, among those patients with unspecified diabetes 4 cases were seen during the age of 20-34 while a magnitude of cases was noted in patients over the age of 40.

                             

In  2001, patients  reported  with foot sepsis in Type 1 diabetics, 67% were males and 33% were females. The males and female were equal (50% each) for type 2 diabetics.

In 2009, there were 26% males reported with foot sepsis and 74% were females. These patients were NIDDM. Among those patients with unspecified diabetes 45% were males and 55 % were females.

DISCUSSION
Diabetic   foot   sepsis   is   developed   through numerous   factors  which  include  neuropathy, peripheral  vascular disease and  hyperglycemia. In   sensory   neuropathy   there   is  diminished perception  of pain  and  temperature,  so delays in injury presentation  are common. Autonomic neuropathy can cause diminished sweat secretion resulting   in   dry,   cracked   skin   facilitating microorganism  entry,  while motor  neuropathy can lead to foot deformities. Due to peripheral artery  disease there  is impaired  blood  supply which  is  needed   for   healing  of  infections. Hyperglycemia weakens neutrophil function and reduces host defenses. Another cause leading to foot sepsis is trauma which slows the healing of wounds leading to secondary infections. Management of diabetic foot infections requires attentive  wound  management  (which  is  relief of pressure on the ulcer, wound cleansing and debridement of callus and necrotic tissue), good nutrition, antimicrobial therapy, glycemic control, and fluid and electrolyte balance.

Conclusion
Diabetes  sepsis  is  prevalent  among  the  two major ethnic groups in Fiji, the Indians and the Fijians. It is common in those over the age of 45 and mostly amongst the females in Fiji. Diabetes sepsis is perhaps a growing problem due to the lack of awareness among the people and maybe even due to the sheer ignorance of some.