An epidemiological study of diabetes-related foot surgeries in Majuro, Republic of the Marshall Islands

Abstract

Introduction: Diabetes is the leading cause of morbidity and mortality in the Marshall Islands (RMI). As the prevalence of diabetes continues to rise, the prevention and management of complications becomes more challenging. Although generally preventable, diabetes-related foot surgeries are among the most frequently reported complication of diabetes in the RMI. Study Aims: 1) To describe the characteristics of patients with diabetes-related foot surgeries among people with diabetes presented to hospital in Majuro, Marshall Islands. 2) To estimate the surgical costs associated with diabetes-related foot surgeries in Majuro, Marshall Islands Methods: A retrospective review of clinical records at Majuro Hospital for the 12-month period January 2015 to December 2015 was conducted to determine patients with diabetes-related foot surgeries (foot ulcer debridement or LLA). Surgical expenditure records were reviewed to estimate the financial costs associated with diabetes-related foot surgeries in the same year. Findings: The prevalence of diabetes-related foot surgeries was found to be 4% of all patients with diabetes. The crude incidence rate of people with major LLA was 103 per 100,000 total population, with all amputations secondary to diabetes. High fasting blood glucose was associated with diabetes-related foot surgeries. Diabetes related foot surgeries was the fourth most common surgical procedure and among the most costly procedures to perform. Conclusion: This study found a decrease in the incidence of diabetes-related foot surgeries when compared with the findings of previous studies from the RMI over 10 years ago. However, all LLA were secondary to diabetes, and a very high rate of diabetes-related foot surgeries persist in the RMI by world standards. This study supports the Non-Communicable Disease Crisis Action plan and highlights the application of the Public Health Model to reducing diabetes-related foot surgeries.