Adequacy of clinical surveillance of diabetic patients requiring minor foot amputations

Abstract

BACKGROUND: Minor amputations related to diabetic foot complications have become increasingly more frequent in Malta. International recommendations suggest a standardised follow-up for diabetic patients. We aim to compare the latter recommendations with a cohort of patients who underwent minor amputation in the years 2014-2017.

METHODS: Data was collected retrospectively from 101 diabetic patients who were admitted to Mater Dei Hospital's Diabetic Foot Ward and required minor amputation. The audit parameters included patient demographics and specifics on the type of amputation, trending of relevant blood investigations prior to surgery and their follow-up history.

RESULTS: A significant proportion of patients never had Hba1c (mean 4-year percentage of 34.4%), lipid (36.6%) or renal profile (23.3%) tested in the years leading to their amputations. Furthermore, the mean total Hba1c levels (9.36%) showed that these patients were mostly uncontrolled diabetics. A very large proportion of these patients were not seen at local health centres/diabetes outpatient clinics (65.3%). The majority had not been seen by a podiatrist (61.4%), nor received diabetes education (84.2%) and had not attended ophthalmic clinics (51.5%) in the years preceding their amputation.

CONCLUSION: Poor compliance with international guidelines for diabetic patients is likely to contribute to the high rate of minor amputations. A co-ordinated effort to improve compliance with international standards relating to diabetes care is urgently required.