Clinical profile and management outcome of diabetic foot ulcers in a tertiary care hospital

To determine major risk factors and management outcome of diabetic foot ulcers in order to prevent amputation. Cross-sectional descriptive study. Study was conducted at the Department of Medicine, Civil Hospital Karachi, from January 2005 to December 2006. One-hundred and sixteen consecutive diabetic patients, with foot ulcers of Wagner's grade 1 to 4 were assessed at baseline for demographic information, detailed history, neuropathy, peripheral pulses and frequency of diabetic complication. Glycemic control was determined on the basis of HbA1c levels. Appropriate medical and surgical treatments were carried out and patients were followed-up until healing or for 6 months as end point of study. Outcome was recorded as healed, incomplete healing and amputated. A majority of subjects had type 2 diabetes [95.7%] with male predominance [66%]. The mean age was 54.29 +/- 7.71 years. Most of the patients were overweight, hyperglycemic and had diabetes > 10 years duration. Neuropathic ulcers were found in 91 [78.4%] patients, while rest of the 25 [22.6%] had neuroischemic ulcers. Wound cultures revealed polymicrobial organisms. Foot ulcers of 89 [77.7%] patients healed without amputation and 17 [14.7%] patients had minor or major amputations. Long-duration of diabetes, poor glycemic control and type of foot ulcers had effect on prognosis [p<0.05]. Effective glycemic control, optimal wound care, aggressive medical management and timely surgical intervention may decrease disabling morbidity with better outcome of diabetic foot ulcer

Diabetic ketoacidosis - a study of 67 episodes in known type 1 and type 2 diabetic patients

Review and describe the clinical characteristics and outcomes of Diabetic Ketoacidosis [DKA] in type land type 2 Diabetic patients. We reviewed the medical records of all patients with a diagnosis of DKA in known diabetics and followed their clinical course and outcome. We classified patients as "type 1" and "type 2" diabetes mellitus based on their treatment history. DKA with recent onset of diabetes excluded because of uncertainty of type of diabetes. We compared the groups for precipitating factors, clinical characteristics and outcomes. Sixty-seven patients fulfilled criteria for inclusion in the study. Of 67 patients 44 [65.7%] were male. Twenty [30%] patients had type 2 diabetes. Mean age of type 1 diabetics was 21.6 +/- 6.lyears while type 2 Diabetics were older and had 48.7 +/- 9 years mean age. Body Mass Index [BMI] and duration of diabetes were greater in type 2 Diabetes. A history of prior DKA was noted in 28 patients and all of them were type 1 Diabetics. Infections were the most common precipitating factor in total [41.8%] but in type 2 Diabetes noncompliance was the main precipitating factor. There were 8 deaths in total and mortality rate was apparently higher in type 2 Diabetes. DKA could frequently complicate type 2 Diabetes contrary to belief and carries relatively high mortality