Outcome of clinical foot examination in relation to self-perceived health and glycaemic control in a group of urban Tanzanian diabetic patients
Introduction
Foot complications are major problems in diabetic patients in industrial countries. The prevalence of peripheral neuropathy (PN) has been reported to be between 13 and 54% in different patient groups 1, 2, 3, 4, 5, while that of peripheral vascular disease (PVD) has varied between 11 and 25% 2, 5, 6.
In African diabetic patients, several earlier studies have reported a lower prevalence of PN and PVD than what was found in European and North American patient groups 7, 8, 9. This could be due to a shorter duration of diabetes in African patients. However, in a recently published study from Sudan [10], the authors found a higher prevalence of PN (37%) and PVD (10%) than earlier reported despite a short duration of diabetes. It is also known that long periods of insulin shortage are common in African countries and lead to high mortality rates in acute diabetes complications and long periods of poor glycaemic control [11]. There is a known correlation between glycaemic control and the development of late complications 12, 13, 14and it has also been reported that European and American diabetic patients with long-term complications and poor glycaemic control experience a deteriorated self-perceived quality of life 15, 16. Because of periods of insulin shortage followed by poor glycaemic control in African diabetic patients, it could be expected that the prevalence of foot complications would be as high as in European patient groups, which in turn, probably affects quality of life. The aim of the current study, therefore, was to highlight foot problems in relation to glycaemic control and quality of life in diabetic patients living in an urban area of Tanzania.
Section snippets
Subjects
The number of diabetic patients registered at the diabetes clinic at Muhimbili Medical Centre (MMC) is unknown. According to the morbidity and mortality study [21]1250 newly diagnosed patients were registered at MMC during a 6 year period (1981–1987). In a follow-up study in 1989 276 of them had died. During a 5-week period (five clinic days) 209 diabetic patients visited the diabetes clinic at MMC. Into the current study patients were selected randomly as the first eight patients entering into
Clinical characteristics and glycaemic control
The mean age of the 153 patients (77 men, 76 women) was 44.2 years (S.D. 14.4 years), the mean age at onset was 39.3 years (S.D. 13.8 years) and the mean duration of diabetes was 5.2 years (S.D. 5.9 years) with 20.4% of the patients having a duration≥10 years. The mean BMI was 24.4 kg/m2 (S.D. 4.8). A total of 18% were classified as underweight, 36% as overweight and 10% as obese. Half of the patient group (50.3%) was treated with oral antidiabetic agents, 36.6% had insulin treatment and 13.1%
Discussion
The findings of a 28% incidence of confirmed neuropathy and 12.5% PVD amongst our diabetes patients are in accordance with most other estimates 1, 2, 3, 4, 10. Modified versions of neuropathy symptoms and disability scores have been used as criteria for PN in different studies. Moreover, it has been demonstrated that PN affects some 13–54% of the diabetic population and PVD, 11–25% [20].
A recent Swedish study [14]and particularly the DCCT study [13], has confirmed a strong association of
Acknowledgements
This work was supported by grants from The Swedish Red Cross and Lions Club, Sweden. We thank Boehringer-Mannheim, Scandinavia for provision of the blood and urine test-equipment.
References (21)
- et al.
Pattern of long-term complications in Sudanese insulin-treated diabetic patients
Diabetes Res. Clin. Pract.
(1995) - et al.
A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population
Diabetologia
(1993) - et al.
The prevalence of foot ulceration and its correlates in type 2 diabetic patients: A population-based study
Diabetic Med.
(1994) - et al.
Risk factors for distal symmetric neuropathy in NIDDM
Diabetes Care
(1994) - et al.
Prevalence and forms of neuropathic morbidity in 800 diabetics
Indian J. Med. Sci.
(1994) - et al.
Foot care assessment in patients with diabetes: a screening algorithm for patient education and referral
Diabetes Educ.
(1995) - et al.
Atherosclerotic risk factors for peripheral vascular disease in non-insulin-dependent diabetic patients
J. Formos Med. Assoc.
(1994) - et al.
The pattern of diabetic complications in Dar es Salam
Trop. Geogr. Med.
(1980) Longstanding diabetes mellitus in Ethiopia: A survey of 105 patients
Diabetologia
(1983)Diabetes in the Nigerian African. Review of long-term complications
Trop. Geogr. Med.
(1976)