Background: Surveillance data from Tanzania during the 1980s and 1990s had shown that the vast majority (>80%) of foot ulcers in persons with diabetes (DM) were neuropathic in origin and not associated with peripheral arterial disease (PAD). However, over the past decade, clinicians have observed an increase in the occurrence of PAD among persons who attend DM clinics at Muhimbili National Hospital (MNH) in Dar es Salaam. We therefore carried out this study to characterize the epidemiology of PAD in a large DM population and identify risk factors.
Methods: During Jan 2014 through Dec 2018, (study-period) and following informed consent, patients who attended MNH DM clinics with foot ulcers were evaluated. We recorded detailed epidemiologic and clinical data, and outcomes. Logistic regression was performed and adjusted odds ratio (AOR) and 95% confidence intervals (CI) calculated.
Results: Of 5,687 enrolled subjects, 3,621 (65%) were male; median BMI was 26.5; median age and diabetes duration were 57 and 8 years, respectively. All patients had some degree of PN; 28% had PAD; ischemic heart disease was uncommon (0.4%). Independent factors associated with PAD included hypertension (AOR: 1.3, CI: 1.1-1.5); tobacco (AOR: 1.4, CI: 1.2-1.7); major amputation (AOR: 3.2, CI: 1.9-5.9); or death (AOR: 2.2, (1.6-3.0). Indians and Arabs were significantly more likely than ethnic Africans to have PAD (p<0.01).
Conclusion: We documented a significant increase in the prevalence of PAD in DM patients in Tanzania—a problem that heretofore was not appreciated. The increase appears to be linked to hypertension and tobacco and likely reflects increasing urbanization of African communities across the African continent, more sedentary lifestyles, lack of exercise, and diet. Underscoring these risks are changes in population demography. PAD is now playing a more substantial role in the pathogenesis of DM foot ulcer in Africa than was previously thought.
Z.G. Abbas: None. L.K. Archibald: None.