Adequacy of clinical surveillance of diabetic patients requiring minor foot amputations.

BACKGROUND Minor amputations of foot complications related to diabetes have become increasingly more frequent in Malta. International recommendations suggest a standardised follow-up for patients with diabetes. We aim to compare the latter recommendations with a cohort of patients who underwent a minor amputation in the years 2014-2017. METHODS Data was collected retrospectively from 101 patients with diabetes who were admitted to Mater Dei Hospital's Diabetic Foot Ward and required minor amputation. The audit parameters included patient demographics, specifics on the type of amputation performed, trending of relevant blood investigations prior to surgery and their follow-up history. RESULTS A significant proportion of patients never had Hba1c (mean 4-year percentage of 34.4%), lipid (36.6%) or renal profile (23.3%) tested in the years leading to their amputations. Furthermore, the mean total Hba1c levels (78.7mmol/mol) showed that these patients with diabetes are mostly uncontrolled. A very large proportion of these patients were not seen at local health centres or diabetes outpatient clinics (65.4%). The majority were not seen by a podiatrist (61.4%), diabetes educators (84.2%) or ophthalmic specialists (51.5%) in the years preceding their amputation. CONCLUSION Poor compliance with international guidelines for patients with diabetes is a contributing factor to the high rate of minor amputations. A co-ordinated effort to improve compliance with international standards relating to diabetes care is urgently required. [ABSTRACT FROM AUTHOR]