THE BURDEN OF DIABETIC FOOT SEPSIS IN TONGA: A Five-Year Review 2013-2017.

Introduction: Anecdotal evidence has shown increased diabetic foot sepsis(DFS) admissions and lower limb amputations and takes up to 60% of our surgical workload. Despite this prevalent problem, there is little to no literature regarding the burden of DFS in Tonga. This study aims to describe the epidemiology of DFS in Tonga from 2013-2017, determine the characteristics of DFS patients, calculate the prevalence of DFS in Tonga and the incidence of lower limb amputation in the diabetic population of Tonga.
Method: Retrospective Descriptive study looking at a total of 658 patients admitted with DFS in 2013-2017 with a retrieval rate of 94%. Statistical analysis was done using SPSS and results were deemed statistically significant using P values.
Results: There is a decreasing trend in DFS admissions. 68% of DFS admissions are female patients and major amputations are large of the female population. This has warranted significant interest to find out why the female population. The results show that factors such as gender, age, BMI, coexisting comorbidities and HBA1c are comparable between the two groups. However, factors such as CBG, the use of traditional Tongan medication, length of stay and having had previous surgery were found to be statistically significant factors with a p-value of .001, <.001, .003 and .002 respectively. Characteristics of DFS patients are mostly female, mean age of 57 in males and 52 in females, obese with a mean BMI of 33, poor glycemic control mean HBA1C of 10.5, and unemployed.
Discussion: Retrospective data and missing data have the potential to cause selection bias. The results of this study have quantified the huge burden diabetic foot sepsis is in Tonga. It has proven statistically significant associations with major amputations that we can use to prevent this occurrence. We have identified those at most risk such as the female population and the need for further prospective study to find the reason for this and ways to counter it. We have identified that the prevalence of diabetic foot sepsis in Tonga is 9.3% which is higher than the global rate of 6% and we can only anticipate and hope that this decreases.