The purpose of this study was to describe patient characteristics and clinical outcome among patients with diabetic foot ulcers under treatment of a multidisciplinary outpatient clinic in multiethnic Suriname, a developing country in South America. Retrospectively, all diabetes patients (> 18 years) with foot ulcers starting their treatment at the outpatient clinic between November 2013 and October 2014 were included and followed for at least 12 weeks. To assess differences in clinical outcome between subgroups, chi-square and incorporating time-related data, the log-rank test were used. One hundred patients were included (lost to follow-up, n = 20). Half of patients were males (n = 40). Mean age was 57.8 years. Nephropathy, peripheral arterial disease, and neuropathy were present in 90.9, 41.7, and 90.3%, respectively. Thirty-five percent of wounds healed within 12 weeks (median at 50 days, 13 visits). Sixty-eight percent of wounds were infected. No major but four minor amputations were carried out. Looking at subgroups, infection and ethnicity (African vs. Asian descent), but not gender or age, increased risk for delayed healing (p < 0.001 and p = 0.049, log-rank test). It seems of high priority to increase awareness and search for accurate preventive strategies for diabetic foot, and related wounds and infections, with special attention for ethnic disparities, in Suriname.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Aguiree F, Brown A, Cho NH, Dahlquist G, Dodd S, Dunning T, et al. IDF Diabetes Atlas Sixth edition. Basel: International Diabetes Federation; 2013.
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2009;87(1):4–14. https://doi.org/10.1016/j.diabres.2009.10.007.
Nishida C, Uauy R, Kumanyika H, Shetty P. The Joint WHO/FAO Expert Consultation on diet, nutrition and the prevention of chronic diseases: process, product and policy implications. Public Health Nutr. 2004;7(1A):245–50.
Krishnadath IS, Nahar-van Venrooij LM, Jaddoe VW, Toelsie JR. Ethnic differences in diabetes and prediabetes in Suriname. BMJ Open Diabetes Res Care. 2016;4(1):e000186. https://doi.org/10.1136/bmjdrc-2015-000186.
World Bank. Countries and economies. Washington, DC: World Bank; 2014.
Algemeen Bureau voor de Statistiek, Censuskantoor. Resultaten Achtste (8e) Volks- En Woningtelling in Suriname (Volume I) Demografische en Sociale Karakteristieken en Migratie, 294/013. Paramaribo: General Bureau of Statistics Suriname; 2013.
Punwasi W. In: Ministry of Health, Bureau of Public Health, editor. Doodsoorzaken in Suriname 2007-2011. Paramaribo: Ministerie van Volksgezondheid, Bureau Openbare gezondheidszorg; 2011.
Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet. 2003;361(9368):1545–51.
Unwin N. The diabetic foot in the developing world. Diabetes Metab Res Rev. 2008;24(Suppl 1):S31–3. https://doi.org/10.1002/dmrr.857.
Reiber GE, Lipsky BA, Gibbons GW. The burden of diabetic foot ulcers. Am J Surg. 1998;176(2):5S–10S. https://doi.org/10.1016/S0002-9610(98)00181-0.
Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217–28. https://doi.org/10.1001/jama.293.2.217.
Bakker K, Apelqvist J, Schaper NC. Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes Metab Res Rev. 2012;28:225–31. https://doi.org/10.1002/dmrr.2253.
Lipsky BA, Peters EJG, Berendt AR, Senneville E, Bakker K, Embil JM, et al. Specific guidelines for the treatment of diabetic foot infections 2011. Diabetes Metab Res Rev. 2012;28:234–5. https://doi.org/10.1002/dmrr.2251.
Tentolouris N, Al-Sabbagh S, Walker MG, Boulton AJ, Jude EB. Mortality in diabetic and nondiabetic patients after amputations performed from 1990 to 1995: a 5-year follow-up study. Diabetes Care. 2004;27(7):1598–604. https://doi.org/10.2337/diacare.27.7.1598.
Lowe J, Sibbald RG, Taha NY, Lebovic G, Rambaran M, Martin C, et al. The Guyana diabetes and foot care project: improved diabetic foot evaluation reduces amputation rates by two-thirds in a lower middle income country. Int J Endocrinol. 2015;2015:920124. https://doi.org/10.1155/2015/920124.
Bertoldi AD, Kanavos P, Franca GV, Carraro A, Tejada CA, Hallal PC, et al. Epidemiology, management, complications and costs associated with type 2 diabetes in Brazil: a comprehensive literature review. Glob Health. 2013;9(1):62. https://doi.org/10.1186/1744-8603-9-62.
Ollendorf DA, Kotsanos JG, Wishner WJ, Friedman M, Cooper T, Bittoni M, et al. Potential economic benefits of lower-extremity amputation prevention strategies in diabetes. Diabetes Care. 1998;21(8):1240–5. https://doi.org/10.2337/diacare.21.8.1240.
Vartanian SM, Robinson KD, Ofili K, Eichler CM, Hiramoto JS, Reyzelman AM, et al. Outcomes of neuroischemic wounds treated by a multidisciplinary amputation prevention service. Ann Vasc Surg. 2015;29(3):534–42. https://doi.org/10.1016/j.avsg.2014.10.030.
Boulton AJ, Meneses P, Ennis WJ. Diabetic foot ulcers: a framework for prevention and care. Wound Rep Reg. 1999;7(1):7–16. https://doi.org/10.1046/j.1524-475X.1999.00007.x.
Faglia E, Favales F, Aldeghi A, Calia P, Quarantiello A, Barbano P, et al. Change in major amputation rate in a center dedicated to diabetic foot care during the 1980s: prognostic determinants for major amputation. J Diab Comp. 1998;12(2):96–102. https://doi.org/10.1016/S1056-8727(97)98004-1.
Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJA. Comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems. Diabetes Care. 2001;24(1):84–8. https://doi.org/10.2337/diacare.24.1.84.
Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12):e132–73. https://doi.org/10.1093/cid/cis346.
Frykberg RG, Piagessi A, Donaghue VM, Schipani E, Haberschaw GM, Navalesi R, et al. Difference in treatment of foot ulcerations in Boston, USA and Pisa, Italy. Diabetes Res Clin Pract. 1997;35(1):21–6. https://doi.org/10.1016/S0168-8227(96)01359-9.
Ribu L, Birkeland K, Hanestad BR, Moum T, Rustoen TA. Longitudinal study of patients with diabetes and foot ulcers and their health-related quality of life: wound healing and quality-of-life changes. J Diabetes Complicat. 2008;22(6):400–7. https://doi.org/10.1016/j.jdiacomp.2007.06.006.
Parisi MC, Zantut-Wittmann DE, Pavin EJ, Machado H, Nery M, Jeffcoate WJ. Comparison of three systems of classification in predicting the outcome of diabetic foot ulcers in a Brazilian population. Eur J Endocrinol. 2008;159(4):417–22. https://doi.org/10.1530/EJE-07-0841.
Morbach S, Lutale JK, Viswanathan V, Mollenberg J, Ochs HR, Rajashekar S, et al. Regional differences in risk factors and clinical presentation of diabetic foot lesions. Diabet Med. 2004;21(1):91–5. https://doi.org/10.1046/j.1464-5491.2003.01069.x.
Ince P, Kendrick D, Game F, Jeffcoate WJ. Use of the SINBAD classification system and score in comparing outcome of foot ulcer management on three continents. Diabetes Care. 2008;31(5):964–7. https://doi.org/10.2337/dc07-2367.
Weledji EP, Fokam P. Treatment of the diabetic foot — to amputate or not? BMC Surg. 2014;14:83. https://doi.org/10.1186/1471-2482-14-83.
Richard JL, Lavigne JP, Sotto A. Diabetes and foot infection: more than double trouble. Diabetes Metab Res Rev. 2012;28:46–53. https://doi.org/10.1002/dmrr.2234.
Bos M, Agyemang C. Prevalence and complications of diabetes mellitus in Northern Africa, a systematic review. BMC Public Health. 2013;13(1):387. https://doi.org/10.1186/1471-2458-13-387.
Prompers L, Apelqvist J. High prevalence of ischemia, infection, and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia. 2007;50(1):18–25. https://doi.org/10.1007/s00125-006-0491-1.
Lazo Mde L, Bernabe-Ortiz A, Pinto ME, Ticse R, Malaga G, Sacksteder K, et al. Diabetic peripheral neuropathy in ambulatory patients with type 2 diabetes in a general hospital in a middle income country: a cross-sectional study. PLoS One. 2014;9(5):e95403. https://doi.org/10.1371/journal.pone.0095403.
Coussons AK, Wilkinson RJ, Nikolayevskyy V, Elkington PT, Hanifa Y, Islam K, et al. Ethnic variation in inflammatory profile in tuberculosis. PLoS Pathog. 2013;9(7):e1003468. https://doi.org/10.1371/journal.ppat.1003468.
The authors thank Priscilla van Brussel, Shakieta Joerawan, Devika Soedamah, and Vern Nanhoe, medical students at the Faculty of Medical Sciences, Anton de Kom University Suriname, for their participation at the data collection and management.
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the national research committee, the Ethics Committee of the Ministry of Health of Suriname, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Because of the retrospective study design, informed consent was not obtained from the subjects. All data were gathered primarily for standard clinical care. To guaranty confidentiality, analyses were on group level and anonymized by coding.
About this article
Cite this article
Nahar - van Venrooij, L.M.W., Pieka, C., Akash, B. et al. Wound infections and recovery time among patients with diabetic foot ulcer living in multiethnic Suriname, a developing country: a retrospective cohort study among patients from the One Stop Shop for chronic diseases Paramaribo. Int J Diabetes Dev Ctries 38, 471–477 (2018). https://doi.org/10.1007/s13410-017-0595-9
- Diabetic foot ulcer
- Developing country
- Ethnic disparity