EFFECT OF BASELINE COMPLICATIONS OR CO-MORBIDITIES ON INCIDENCE OF DIABETIC FOOT ULCER AMONG ADULT DIABETIC PATIENTS ATTENDING PUBLIC HOSPITALS, HADIYA ZONE, SOUTHERN ETHIOPIA

Abstract

Diabetic foot disease is a major medical, social, and economic problem that is, seen in every continent and constitutes a major burden to the patient and the health care system. The lifetime risk of a person with diabetes developing diabetic foot ulcers is as high as 25%. As the best knowledge of investigator, there was limited evidence on effect of baseline complications and co-morbidities on incidence of diabetic foot ulcer among adult patients on diabetic care follow up in the study areas. Objective: to determine the effect of baseline complications and co-morbidities on incidence of diabetic foot ulcer among adult diabetic patients attending public hospitals of Hadiya zone, southern Ethiopia, from 1 January 2015 to 31 December 2019. Methods: An institution based retrospective cohort study was conducted in Hadiya Zone Public Hospitals, from March 01-15, 2020. The data were collected from individual folder and database by using data extraction format for 200 exposed and 201 unexposed populations. Kaplan-Meier failure curves were used to estimate the probability of developing diabetic foot ulcer. The Cox proportional hazard model was used to determine the effect of baseline complications or co-morbidities on diabetic foot ulcer occurrence. Adjusted hazard ratio was estimated and interpreted with 95% CI at p-value < 0.05. Results: The incidence rate of diabetic foot ulcer was 4.7/1000 person-months with 95% CI of (3.1/1000, 7.1/1000) in the group with at least one baseline complications (co-morbidities) and 0.93/1000 person-months with 95% CI of (0.35/1000, 2.5/1000) in the cohort without at least one baseline complications (co-morbidities), respectively. Baseline complications or co-morbidities that were found to have significant effect on diabetic foot ulcer were retinopathy (AHR=3.43, 95% CI; 1.11 10.59), nephropathy (AHR=2.86, 95% CI; 1.19 6.89), peripheral neuropathy (AHR =6.19, 95% CI; 1.98 19.38), peripheral vascular diseases (AHR= 3.04, 95% CI; 1.19 7.76) and obesity (AHR=5.99, 95% CI; 1.71 21.05). Conclusions: The overall incidence of diabetic foot ulcer was high in the study population. Health professionals should give tailored advice on major complications and co-morbidities of DM for all adult patients at initiation of DM treatment.