A three-nation study on post-amputation outcome in patients with diabetes has indicated that the chances that they develop other complications that can be life-threatening are pretty high.

The study, published in Diabetes Research and Clinical Practice, the official journal of the International Diabetes Federation, aimed at investigating the assumption that mortality is pretty high after any major amputation (above/below the knees).

“A couple of earlier studies showed that survival rates post-amputation are very poor. Therefore the suspicion is that patients in developing nations will do badly too,” Vijay Vishwanathan, of M.V. Hospital for Diabetes, Royapuram, and co-author of the report, said.

M.V. Hospital conducted the Indian arm of the study, while Quader Memorial Diabetic Foot Care Hospital, Bangladesh, handled the study for that nation; and the Muhimbili University College of Health Sciences and Abbas Medical Centre, collaborated on the Tanzania wing. A total of 526 (Type 2 Diabetes) patients who had undergone an amputation between 2002 and 2004 were followed up until 2008 for post-surgery mortality and morbidity.

The prevalence of amputations was similar in all centres. A combination of socio-cultural factors thanks to which people walk barefoot and lack of awareness on foot care in the three developing nations were at the heart of this heightened chances of diabetic foot nephropathy. “The foot is the most neglected part of the body, especially in developing nations. But if you have a bad foot complication, the chances are that you will have to undergo a major or minor amputation. This is completely avoidable, if only foot care is prioritised.”

Researchers showed that the high-mortality predicted post-surgery was indeed a fact. In Tanzania, it was highest, as 31 per cent of the patients studied died during the follow up period. India followed with 16 per cent deaths and Bangladesh was relatively better off with 5 per cent. The most common causes of death were heart attacks or renal failure, and infection.

The recurrence of foot ulceration was also high in Tanzania at 11 per cent. In India, it was 9 per cent and in Bangladesh, 11 per cent. Though the patients were given awareness messages on how best to take care of the foot, compliance was pretty low, according to the authors.

“The only good news is that re-amputation, or amputation of the other leg, within three years of the first surgery is only three per cent in all three groups, consisting of patients across the income spectrum,” Dr. Vijay added. However, there is the entire spectrum of psychological and psychiatric factors associated with limb loss that have to be factored in. “It is clear that once a person has a major amputation, things are not going to be rosy. There is a good chance they will have other complications related to diabetes too —cardiac, renal and retinopathy (vision). The best course would be to avoid these complications, but even later, good sugar control is essential,” Dr. Vijay summarised.

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