DIABETIC FOOT SEPSIS IN FIJI: INCIDENCE AND REVIEW OF LITERATURE
Author: Sharma V
Keywords: Diabetes, Foot sepsis, amputation
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.
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.
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.
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.
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.