Endocrine Abstracts

Introduction and aim: Diabetic foot (DF) is associated with increased morbimortality and cost of diabetes management. The aim of this study is to describe the epidemiological, clinical and paraclinical characteristics and follow-up outcomes of patients with diabetic foot in a Tunisian center.

Methods: It is a monocentric retrospective study of 210 patients with diabetic foot followed at the endocrinology department of the Hedi Chaker Sfax University Hospital between 1997 and 2020.

Results: Patients were predominantly men (79.6%), aged 59.14±12.24 years on average. Over 85% of patients were type2 diabetics, 90.4% of whom had a chronically imbalanced condition. In our population, diabetes has been diagnosed since 13.21±8.2 years while DF was the revealing factor of diabetes in 7 patients (3.4%). Approximately one third of the patients lived in poor socioeconomic conditions and 24% were illiterate. Half of the patients were obese and 25.2% were smokers. The mean time to consultation was 45.83 days (median = 15 days). The most common reason for admission was major hyperglycemia associated with DF (75.1%) while ketoacidosis was found in 29 patients (14.1%). Half of patients had lower limb arterial disease (LLAD) upon admission while peripheral neuropathy was present in 81.6% of patients. The most frequent triggers of DF were unfelt trauma (26.7%) and foot-shoe conflict (12.1%). The involvement was bilateral in 51 patients. Clinical findings showed DF infection, ulceration and plantar perforation were present in 72, 62 and 59 cases respectively. Eighteen percent patients were at gangrene stage upon admission. Lab investigation showed a mean blood glucose level at 15 ± 6.81 mmol/l. The most frequently isolated germ was Staphylococcus aureus (29 cases). Antibiotic therapy was prescribed in 62.1% of cases for a mean duration of 19.9 ±18.6 days. Amputation was the outcome for 44 patients and the mortality rate was 1.9%. In monovariate analysis, the predictive factors for amputation were the presence of LLAD (OR=4; P = 0.02), osteitis (OR=34; P < 0.001) and gangrene (OR=18; P < 0.001).

Conclusion: Despite major advances in therapeutic options, DF remains a major public health issue. Therapeutic education and primary prevention are essential to reduce the frequency and severity of DF complications and ensure early management.