Epidemiological, clinical and prognostic factors in diabetic foot amputations at Souss Massa Agadir University Hospital

Introduction: The diabetic foot is a real public health problem whose prognosis is dominated by a still high rate of lower limb amputation, even in countries with a high socioeconomic level.We conducted this study with the aim of describing the clinical, paraclinical, therapeutic and evolutionary aspects of the diabetic foot hospitalized in our department and also to define the prognostic factors influencing the progression to amputation. Materials and method: This is a retrospective descriptive and analytical study spread over a period of 11 months (June 2022-May 2023) involving 60 diabetic patients admitted for diabetic foot at the Department of Diabetology and Metabolic Diseases Endocrinology at the Souss Massa Hospital. Results: The mean age was 62.45 years, and the sex ratio was 5. The majority of our patients had type 2 diabetes (93.3%), with a mean duration of diabetes of 14 years. The mean glycated hemoglobin (HbA1c) was 10.10%.The average consultation time was 36.5 days. All patients had associated risk practices (barefoot, inappropriate footwear, poor hygiene, etc.).The starting point of the foot lesions was trauma, which resulted in a superinfected wound in 43% of cases. Damage to the forefoot predominated (45% of cases). Gangrene was the main lesion found (53%). Neuropathy was the main etiopathogenic factor (83%). The majority of lesions (67%) were Wagner grade 4 and 5. 28.3% of patients underwent surgical debridement and 63.3% underwent amputation as follows 51.7% were minor amputations (toe regularisation in 19% of cases and forefoot amputation in 32.7% of cases). Major transtibial amputation was performed in 7 patients (11.7%). There were no deaths in the study. In our study, factors favouring amputation were: patient age > 70 years (p=0.01), glycaemic control: HbA1C>8% (p=0.03), lack of diabetes control (p=0.03), presence of arteriopathy (p=0.003), osteitis (p=0.019), Wagner stage 4 and 5 (p<0.001), previous foot amputation (p=0.005), infection (p=0.004). Factors not associated with amputation were (male) sex (p=0.749), nephropathy (p=0.476), hypertension (p=0.457), retinopathy (p=0.274), neuropathy (p=0.400), heart disease (p=0.902), dyslipidaemia (p=0.096). Conclusion: The majority of our patients are unattended, unbalanced, late seekers with advanced lesions and a high amputation rate. This may be related to patient ignorance, illiteracy and lack of knowledge about diabetes and its complications, as well as difficulties in accessing care and low socio-economic status. The fight against diabetic foot is based on prevention: education of patients and caregivers on the one hand, and multidisciplinary, concerted management on the other.