Prevalence, Risk factors and Predictors of Diabetes-related Complications: Foot ulcers, Lower extremity amputations and Sexual dysfunction in three selected hospitals in Ghana
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Date
FEBRUARY, 2016
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Abstract
The prevalence and complications of diabetes is currently on the rise, thus this study investigated the prevalence, risk factors and predictors of diabetic foot ulcers, lower extremity amputations and sexual dysfunction to improve preventive strategies and care for diabetics. The study was a cross-sectional multicenter study conducted over a period of two months from June to July, 2015. It was carried out at the Korle Bu Teaching Hospital, Komfo Anokye Teaching Hospital and Tamale Teaching Hospital and involved 100 diabetics randomly selected from the diabetes clinics of the study facilities. The socio-demographic characteristics, medical history, lifestyle variables, physical characteristics and sexual dysfunction of the participants were investigated using a structured questionnaire. Blood samples were also taken from subjects and analyzed for triglycerides, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, serum creatinine and serum urea. Estimated glomerular filtration rate was also determined using the serum creatinine. The sex distribution of the study participants was 31% males and 69% females with a mean age of 53.82±13.754 years. Among the patients, 11% had diabetic foot ulcers, 3% had lower extremity amputation and 54.8% and 68.1% of males and females had sexual dysfunction respectively. The prevalence of sexual dysfunction severity was 6.5% and 4.3% in males and females respectively. In univariate analysis the significant factors associated with diabetic foot ulcers were previous history of foot ulcers (p=0.000), foot deformities (p=0.002), impaired vision (p=0.042), serum creatinine (p=0.023) and estimated glomerular filtration rate (p=0.029). In the multivariate binary logistic regression analysis, only previous history of foot ulcers (OR= 40.441, 95% CI=5.453-299.93) and foot deformities (OR= 14.388, 95% CI=1.284-161.24) were identified as independent predictors of diabetic foot ulcers. Foot deformities (P=0.043) and serum urea (P=0.002) were significantly associated with diabetic lower extremity amputations in the univariate analysis. In the multivariate binary logistic regression analysis, only high serum urea (OR= 45, 95% CI=2.0015-1004.773) was identified as an independent predictor of diabetic lower extremity amputations. However, none of the independent variables were associated with sexual dysfunction in both men and women in the univariate analysis. This study has shown that the prevalence of diabetic foot ulcers, lower extremity amputations and sexual dysfunction are high among diabetics. Foot deformities and previous history of foot ulcers were predictive of diabetic foot ulcers while renal failure (high serum urea) was predictive of diabetic lower extremity amputations. Based on the findings of the present study, it is recommended that, interventions geared towards the prevention of foot ulcers, lower extremity amputations and sexual dysfunction in diabetics should be implemented.
Description
A Thesis submitted to the Department of Biochemistry and Biotechnology,
College of Science,
in partial fulfillment of the requirements for the degree of Master of Philosophy in (Human Nutrition and Dietetics)