017: The Prevalence of Diabetic-Related Foot and Lower Limb Amputations at Tertiary Hospitals in Gauteng-South Africa-A wake-up call  

Primary Author:

Introduction 

There is a significant concern about diabetic foot amputations among both patients and healthcare professionals in South Africa. However, there is a lack of data regarding the prevalence of diabetic foot complications and amputations. This absence of information may contribute to ongoing disparities in care and the absence of a comprehensive strategy to tackle the growing issue of diabetes-related foot amputations.  

Methods 

A retrospective theatre file review was undertaken for this study. Theatre records of all diabetic-related amputations between January 2020 and June 2022 were reviewed. Data were analysed using simple descriptive statistics. The Chi-Square test was used to determine an association between categorical variables.   

Results

A total of 1862 diabetic-related foot amputations were identified from the hospitals' theatre records, but 297 records could not be recovered, leaving 1565 records for analysis. The mean age was 60.5; 62% of patients were males, 26% of amputees were younger than 55, 46% had no direct source of income, and 52% had an income of ZAR70 000 ($4,018) per annum. 73% of all first amputations were major amputations, and 75% of these were due to foot sepsis.

Discussion

The data presented in this study were collected from tertiary hospitals in Gauteng, which are all referral hospitals. The findings indicate a concerning outcome for many diabetic patients. The majority of first amputations were major amputations, which may be attributed to delayed presentations, possibly due to various factors. Among these factors, early access to foot health services and appropriate referral pathways are crucial.

There is a need to review the care provided at all levels for diabetic patients. Risk factors should be identified and managed early at the appropriate level of care. The study’s findings reveal a troubling trend: patients undergoing amputations are predominantly under the age of 55, a demographic that should be economically active.

South Africa's healthcare delivery system is primarily the district health system (DHS), which places primary healthcare at the centre of healthcare delivery. There is a need to relook at how these facilities or levels of care could be re-engineered to speak to diabetic foot complications early and possibly avoid the ever-increasing number of amputations.

018: Smart Insoles for Preventing Diabetic Foot Ulcers  
Submitter: Maria Caluianu – Walk With Path Ltd. 

Primary Author (s):

Co-Author(s):

Introduction   
>5.6 million people are estimated to have diabetes in the UK. 25% of individuals with diabetes go on to develop diabetic foot ulcers (DFUs) in their lifetimes¹. DFUs take significant time to heal and often lead to amputations. Current DFU prevention methods are inadequate, resulting in 40% of DFUs recurring within a year². DFU treatment and amputations also have a significant environmental cost due to the single-use consumables used in assessment and treatment which must be incinerated following use.   

Methods

To tackle this, we hypothesize that using smart temperature and pressure sensing insoles to predict DFUs before they form and acting early can prevent DFUs. To this end, user testing was carried out using smart, DFU-predicting insoles*.

Results   
The average participant age for user testing was 60.4 years, All users stated that they would act to prevent a DFU if DFU-predicting insoles* alerted them to do so. Most were comfortable with using phone apps and having their data collected and shared with their healthcare providers.   

Discussion  
We have shown that potential users are ready to adopt such devices into their care. Thus, smart DFU-predicting insoles present a promising device in DFU prevention.   

Trademarked Items   
*Path Active (Walk With Path Ltd.) 

References   
1. North West Coast Strategic Clinical Network: Diabetes Footcare Pathway Blueprint (Mackenzie P., 2017). 2. Voelker R. What Are Diabetic Foot Ulcers? JAMA. 2023;330(23):2314. doi:10.1001/jama.2023.17291 3. Abbott CA, Chatwin KE, Foden P, et al. Innovative intelligent insole system reduces diabetic foot ulcer recurrence at plantar sites: a prospective, randomised, proof-of-concept study. Lancet Digit Health. 2019;1(6):e308-e318. doi:10.1016/S2589-7500(19)30128-1