Treatment of diabetic foot lesions in hospital: results of 2 successive five-year periods, 1989-1993 and 1994-1998

OBJECTIVES: To assess the impact of an educational training program we initiated in 1994 for GPs about diabetic foot ulcer (DFU) management, we compared the rate and level of lower limb amputation (LLA) in diabetic patients performed in our unit between two consecutive five-year periods, 1989-1993 and 1994-1998. PATIENTS AND METHODS: During the first period, 132 patients with 163 lesions (9.2% of the total admissions for diabetes) were compared with 176 with 183 lesions (10.5%) during the second period. Patients' mean age was the same in both periods: 59.6 +/- 11.7 in 1989-1993 and 58.3 +/- 13.1 in 1994-1998 [Not statistically significant, NS]. RESULTS: Patients age, sex ratio, type of diabetes and severity of the lesion (as assessed according to Wagner classification) were essentially the same during the two periods. Most of the foot lesions ( approximately 90%) were purely neuropathic or neuro-ischaemic, with no change in repartition between the two periods. Primary healing was 59.1% in the 1st period and 56.8% in the second. No change in minor and major amputation rate was observed between the 1st period (14.4 and 15.9%, respectively) and the second (11.4 and 16.5%, respectively). The in-hospital mortality rate was unchanged (9.1 vs 8.5%, NS), while the percentage of patients who left hospital against medical advice and dropped out of follow up increased from 1.5 to 6.8% (p<0.04). Mean length of hospitalisation was identical, about 43 days. CONCLUSIONS: In spite of implementing educational program for GPs, no improvement in the DFU management was noted as emphasised by absence of any significant change in amputation rate before (1st period) and after initiating the program (2nd period). These disappointing results can be explained by several factors: weakness of our educational program, lack of motivation from GPs, absence of a structured multidisciplinary prevention approach. The main problem, common to developing countries, remains the insufficiency of financial resources. Moreover, civil disturbances can make the problem more difficult to manage, as in Algeria since 1991.