Outcome of diabetic foot ulcer admissions at the medical wards of University of Nigeria Teaching Hospital Enugu, Nigeria

  • Ekenechukwu E. YoungEmail author
  • Obumneme B. Anyim
  • Belonwu M. Onyenekwe
  • Chidinma B. Nwatu
  • Christian I. Okafor
  • Esther N. Ofoegbu
Original Article


Diabetic foot ulcer (DFU) is associated with a high rate of morbidity, prolonged hospital stay, and serious complications including limb amputation. The objective of this study was to determine the outcome of DFU among medical inpatients in the University of Nigeria Teaching Hospital Enugu, Nigeria. Data from case records of diabetes-related admissions into the medical wards of the University of Nigeria Teaching Hospital Enugu (UNTH) between January 2009 and December 2012 were analyzed. Statistical analysis was done using SPSS v17. Out of 726 diabetes mellitus (DM)-related admissions (59.1 % males, 40.9 % females), DFU accounted for 119 (16.4 %), of which 65.5 % were males and 34.5 % were females. The mean duration of diabetes in DFU patients was 7.2 ± 5.8 years, while the median (interquartile range) duration of the ulcer before the presentation was 24 (14–60) days. The mean age of patients with DFU was 55.2 ± 13.2 years, while the duration of hospital stay ranged from 2 to 98 days, median (interquartile range (IQR)) of 16 (9.8–30.3) days. Out of the 119 DFU admissions, 88 (73.9 %) were discharged, 15 (12.6 %) died, while 16 (13.5 %) discharged themselves against medical advice (DAMA). Of those who were discharged, about 75 % were discharged with non-healed ulcers either for outpatient care or to surgical units. The most common Wagner grade of ulcer was grade 3 (41.5 %). Risk factors for ulceration were peripheral vascular disease in 47.1 % and peripheral neuropathy in 57.6 %. Mortality due to DFU accounted for 10.6 % of all diabetes mortality. Diabetic foot ulcer was a common reason for admission and characterized by late presentation and advanced ulcer stage. Diabetes foot ulcers admitted and managed in the medical wards were associated with poor outcome.


Diabetes Foot ulcer Outcome Mortality Medical wards 


Conflict of interest



  1. 1.
    Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–53.CrossRefPubMedGoogle Scholar
  2. 2.
    Adeleye JO. Diabetic foot disease: the perspective of a Nigerian tertiary health care centre. Pract Diabetes Int. 2005;22(6):211–4.CrossRefGoogle Scholar
  3. 3.
    Joshi SR, Das AK, Vijay VJ, Mohan V. Challenges in diabetes care in India: sheer numbers, lack of awareness and inadequate control. J Assoc Physicians India. 2008;56:443–50.PubMedGoogle Scholar
  4. 4.
    Dalal S, Beunza JJ, Volmink J, Adebamowo C, Bajunirwe F, Njelekela M. Non-communicable diseases in sub-Saharan Africa: what we know now. Int J Epidemiol. 2011;40:885–901.CrossRefPubMedGoogle Scholar
  5. 5.
    American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36:1033–46.CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Aronson D. Hyperglycemia and the pathobiology of diabetic complications. Adv Cardiol. 2008;45:1–16. doi: 10.1159/0000115118.CrossRefPubMedGoogle Scholar
  7. 7.
    Brownlee M. Banting Lecture 2004. The pathobiology of diabetic complications: a unifying mechanism. Diabetes. 2005;54:1615–25.CrossRefPubMedGoogle Scholar
  8. 8.
    Dinh TL, Veves A. A review of the mechanisms implicated in the pathogenesis of the diabetic foot. Int J Lower Extrem Wounds. 2005;4:154–9.CrossRefGoogle Scholar
  9. 9.
    Ogbera AO, Fasanmade O, Ohwovoriole AE, Adediran O. An assessment of the disease burden of foot ulcers in patients with diabetes mellitus attending a Teaching Hospital in Lagos, Nigeria. Int J Lower Extrem Wounds. 2006;5:244–9.CrossRefGoogle Scholar
  10. 10.
    Margolis D, Malay DS, Hoffstad OJ, et al. Incidence of diabetic foot ulcer and lower extremity amputation among Medicare beneficiaries, 2006 to 2008. Data Points #2 (prepared by the University of Pennsylvania DEcIDE Center, under Contract No. HHSA29020050041I). Rockville, MD: Agency for Healthcare Research and Quality. January 2011. AHRQ Publication No. 10(11)-EHC009-1-EF. Available online at Accessed 25 Feb 2015.
  11. 11.
    Reiber GE, Lipsky BA, Gibbons GW. The burden of diabetic foot ulcers. Am J Surg. 1998;176:5S–10.CrossRefPubMedGoogle Scholar
  12. 12.
    Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217–28.CrossRefPubMedGoogle Scholar
  13. 13.
    Deribe B, Woldemichael K, Nemera G. Prevalence and factors influencing diabetic foot ulcer among diabetic patients attending Arbaminch Hospital, South Ethiopia. J Diabetes Metab. 2014;2:322. doi: 10.4172/2155-6156.1000322.Google Scholar
  14. 14.
    Chinenye S, Uloko AE, Ogbera AO, Ofoegbu EN, Fasanmade OA, Fasanmande AA, et al. Profile of Nigerians with diabetes mellitus—Diabcare Nigeria study group (2008). Indian J Endocrinol Metab. 2012;16:558–64.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Unachukwu C, Babatunde S, Ihekwaba AE. Diabetes, hand and/or foot ulcers: a cross-sectional hospital-based study in Port Harcourt Nigeria. Diabetes Res Clin Pract. 2007;75:148–52.CrossRefPubMedGoogle Scholar
  16. 16.
    Otu AA, Umoh VA, Essien OE, Enang OE, Okpa HO, Mbu PN. Profile, bacteriology, and risk factors for foot ulcers among diabetics in a tertiary hospital in Calabar, Nigeria. Ulcers, vol 2013; Article ID 820468, 6 pages, 2013. doi: 10.1155/2013/820468.
  17. 17.
    Ogbera AO, Adedokun A, Fasanmade OA, Ohwovoriole AE, Ajani M. The foot at risk in Nigerians with diabetes mellitus: the Nigerian scenario. Int J Endocrinol Metab. 2005;4:165–73.Google Scholar
  18. 18.
    Ray AS. Diabetic foot ulcer: a serious problem for diabetic patient; PharmaTutor 2014;2(10): 23–26.Google Scholar
  19. 19.
    Ngwogu KO, Umez-Emeana EC, Ngwogu AC. The burden of diabetic foot ulcers in Aba, Abia State, Nigeria. Int J Basic Appl Innov Res. 2013;2(4):118–24.Google Scholar
  20. 20.
    American Diabetes Association. Consensus development conference on diabetic foot wound care. 1999, Boston, Mass Adv Wound Care. 1999;12:353–361.Google Scholar
  21. 21.
    Brod M. Quality of life issues in patients with diabetes and lower extremity ulcers: patients and caregivers. Qual Life Res. 1998;7:365–72.CrossRefPubMedGoogle Scholar
  22. 22.
    Margolis DJ, Kantor J, Berlin JA. Healing of diabetic neuropathic foot ulcers receiving standard treatment: a meta-analysis. Diabetes Care. 1999;22:692–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Elgzyri T, Larsson J, Thörne J, Eriksson K-F, Apelqvist J. Outcome of ischemic foot ulcer in diabetic patients who had no invasive vascular intervention. Eur J Vasc Endovasc Surg. 2013;46(1):110–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Piaggesi A, Schipani E, Campi F, et al. Conservative surgical approach versus non-surgical management for diabetic neuropathic foot ulcers: a randomised trial. Diabet Med. 1998;15:412–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Yesil S, Akinci B, Yener S, Bayraktar F, Karabay O, Havitcioglu H, et al. Predictors of amputation in diabetics with foot ulcer: single center experience in a large Turkish cohort. Hormones. 2009;8(4):286–95.CrossRefPubMedGoogle Scholar
  26. 26.
    Boulton AJ, Vilekyte L, Ragnoson-Tenvall G, et al. The global burden of diabetic foot disease. Lancet. 2005;366(9498):1719–24.CrossRefPubMedGoogle Scholar
  27. 27.
    Inlow S, Orstead H, Sibbald RG. Best practices for the prevention, diagnosis, and treatment of diabetic foot ulcers. Ostomy Wound Manag. 2000;46(11):55–68.Google Scholar
  28. 28.
    Barshes NR, Sigireddi M, Wrobel JS, Mahankali A, Robbins JM, Kougias P, et al. The system of care for the diabetic foot: objectives, outcomes, and opportunities. Diabet Foot Ankle. 2013;4:21847. doi: 10.3402/dfa.v4i0.21847.CrossRefGoogle Scholar
  29. 29.
    Bakker K, van Houtum WH, Riley PC. 2005: the International Diabetes Federation focuses on the diabetic foot. Curr Diab Rep. 2005;5(6):436–40.CrossRefPubMedGoogle Scholar
  30. 30.
    Population distribution by sex, state, LGA & senatorial district. 2006 Population and Housing Census. Published in Federal Government official gazette number 2, volume 96 of 2nd February, 2009.Google Scholar
  31. 31.
    Wagner FW. The dysvascular foot: a system of diagnosis and treatment. Foot Ankle. 1981;2:64–122.CrossRefPubMedGoogle Scholar
  32. 32.
    UK Prospective Diabetes Study (UKPDS) Group. Intensive blood glucose control with sulphonyl ureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.CrossRefGoogle Scholar
  33. 33.
    Diabetes Control and Complications Trial (DCCT) Research Group. The relationship of glycaemic exposure (HbA1c) to the risk of development and progression of retinopathy in the diabetes control and complications trial. N Eng J Med. 1993;329:977–86.CrossRefGoogle Scholar
  34. 34.
    Ajayi EA, Ajayi AO. Pattern and outcome of diabetic admissions at a federal medical center: a 5-year review. Ann Afr Med. 2009;8:271–5.CrossRefPubMedGoogle Scholar
  35. 35.
    Hennessey PJ, Ford EG, Black CY, Andrassy RJ. Wound collagenase activity correlates directly with collagen glycosylation in diabetic rats. J Pediatr Surg. 1990;25:75–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Marhoffer W, Stein M, Maeser E, Federlin K. Impairment of polymorphonuclear leukocyte function and metabolic control of diabetes. Diabetes Care. 1992;15(2):256–60.CrossRefPubMedGoogle Scholar
  37. 37.
    Ikeh EI, Peupet F, Nwadiaro C. Studies on diabetic foot ulcers in patients at Jos University Teaching Hospital, Nigeria. Afr J Clin Exp Microbiol. 2003;4:52–61.CrossRefGoogle Scholar
  38. 38.
    Unachukwu CN, Uchenna DI, Young E. Mortality among diabetes in-patients in Port Harcourt, Nigeria. Afr J Endocrinol Metab. 2008;7:1–4.Google Scholar
  39. 39.
    Moulik PK, Mtonga R, Gill G. Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology. Diabetes Care. 2003;26:491–4.CrossRefPubMedGoogle Scholar
  40. 40.
    Issues in the new poverty report, This Day Live Newspaper 21, 2013,
  41. 41.
    Ngwogu KO, Ekpo BO, Akpuaka FC, Ngwogu AC, Okhiai O. The prevalence of obesity as indicated by body mass index among apparently healthy adults living in Aba, Abia State, Nigeria. Int J Basic Appl Innov Res. 2012;1:19–24.Google Scholar
  42. 42.
    Weck M, Slesaczeck T, Paetzold H, Muench D, Nanning T, von Gagern G, et al. Structured health care for subjects with diabetic foot ulcers results in a reduction of major amputation rates. Cardiovasc Diabetol. 2013;12:45. Scholar
  43. 43.
    Sumpio BE, Armstrong DG, Lavery LA, Andros G, SVS/APMA writing group. The role of interdisciplinary team approach in the management of the diabetic foot. A Joint Statement from the Society for Vascular Surgery and the American Podiatric Medical Association. J Vasc Surg. 2010;51:1504–6.CrossRefPubMedGoogle Scholar
  44. 44.
    Kim PJ, Attinger CE, Evans KK, Steinberg JS. Role of the podiatrist in diabetic limb salvage. J Vasc Surg. 2012;56:1168–72.CrossRefPubMedGoogle Scholar
  45. 45.
    Oguejiofor OC, Odenigbo CU, Oguejiofor CBN. Evaluation of the effect of duration of diabetes mellitus on peripheral neuropathy using the United Kingdom screening test scoring system, bio-thesiometry and aesthesiometry. Niger J Clin Pract. 2010;13:240–7.PubMedGoogle Scholar
  46. 46.
    Schirmer S, Ritter R-G, Fansa H. Vascular surgery, microsurgery and supramicrosurgery for treatment of chronic diabetic foot ulcers to prevent amputations. PLoS ONE. 2013;8(9):e74704. doi: 10.1371/journal.pone.0074704.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Ogbera AO, Eregie O, Edo A, Ekebegh C. Common clinical features of diabetic foot ulcers; perspectives from a developing nation. Int J Lower Extrem Wounds. 2008;7:93–8.CrossRefGoogle Scholar
  48. 48.
    Thewjitcharoen Y, Krittiyawong S, Porramatikul S, Parksook W, Chatapat L, Watchareejirachot O, et al. Outcomes of hospitalized diabetic foot patients in a multi-disciplinary team setting: Thailand’s experience. J Clin Transl Endocrinol. 2014;1:187–91.CrossRefGoogle Scholar
  49. 49.
    Jeffcoate WJ, Ince P, Chipchase SY. Assessing the outcome of the management of diabetic foot ulcers using ulcer-related and person-related measures. Diabetes Care. 2006;29:1784–7.CrossRefPubMedGoogle Scholar

Copyright information

© Research Society for Study of Diabetes in India 2015

Authors and Affiliations

  • Ekenechukwu E. Young
    • 1
    • 2
    Email author
  • Obumneme B. Anyim
    • 2
  • Belonwu M. Onyenekwe
    • 1
    • 2
  • Chidinma B. Nwatu
    • 1
    • 2
  • Christian I. Okafor
    • 1
    • 2
  • Esther N. Ofoegbu
    • 1
    • 2
  1. 1.Department of Medicine, College of MedicineUniversity of NigeriaEnuguNigeria
  2. 2.Department of MedicineUniversity of Nigeria Teaching Hospital EnuguEnuguNigeria

Personalised recommendations