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Discussion

The paper aims to shed light on the risk factors of lower limb amputation in diabetic patients in Saudi Arabia. Diabetic foot complications are a significant public health issue globally, particularly in Saudi Arabia, where diabetes is highly prevalent. Diabetes mellitus (DM) is a prevalent endocrinopathy with several complications, namely diabetic foot ulcers (DFUs), leading to limb amputation. (Musa et al., 2018). Treatment of DFUs is challenging, and it often becomes infected, and people require hospitalization. Over five years course, DM raises the incidence of lower extremity amputations (LEA) by 56% (Musa et al., 2018). Given the increasing expansion of the diabetic population and the rising prevalence of DFUs, diabetes-associated LEAs are expected to remain a major cause of mortality and morbidity. The paper analyzes various research studies and discusses the risk factors.

Al-Rubeaan et al., (2017) stated that Saudi Arabia is struggling with type 2 diabetes, ranking seventh among nations with high diabetes occurrence rates. The occurrence of diabetes-associated morbidities in Saudi Arabia is one of the world’s highest. In Saudi Arabia, diabetic foot complications include amputations, foot ulcers and gangrenes. DFU is developed in diabetic patients, and most patients require amputation. Elevated blood glucose levels, angiopathy, neuropathy and physical stress also cause DFU. Ulcer infection is a leading cause of prolonged hospitalization and morbidity, resulting in nearly twice amputation rates than non-infected ulcers. Reading AlSofyani et al., (2016), who conducted a study on diabetic individuals in Saudi Arabia, it is known that DM is the most common factor linked to amputation. DM affects nearly one-third of Saudi Arabia’s population, which is expected to be doubled by 2030 (AlSofyani et al., 2016). A severe lower limb amputation results in loss of mobility and impacts the patient’s mental and physical well-being. The researchers further stated that DM is becoming more common, and DM combined with factors such as lack of early identification of cardiovascular disease may increase the disease burden, and lower extremities amputation rates may be affected. In Saudi Arabia, lower-extremity amputations are widespread among individuals with type 2 diabetes mellitus (T2DM). Reading Alshammary et al., (2020), it is known that DM is on the rise in Saudi Arabia, and DFU is a significant complication that affects healthcare expenses and life quality. Researchers attempted to evaluate the cost of standard DFU treatments and identified various factors that significantly impact the management costs. Admission costs of patients, medications, investigations and dressings are included in DFU management. In DFU management, the healthcare costs are significantly high, with surgical procedures and hospital admissions accounting for most costs. Compared to treating a diabetic individual without ulceration, the expense of care for diabetic individuals with lower extremity ulcers is a major economic burden (Alshammary et al., 2020). Further reading shows that better glycemic control and patient education on the risks of the diabetic foot and precautionary activities could result in significant savings in healthcare expenditure. Early detection of foot issues with appropriate interventions could lead to better outcomes by lowering major amputation needs.

Conclusion

A retrospective study by Almohammadi et al., (2022) in Saudi Arabia that included diabetic patients with foot gangrenes or DFU revealed that participants who underwent amputation presented gangrene and chronic foot ulcers. The average blood glucose levels and WBC count were high for the individuals with DFUs. The danger of diabetic-foot associated amputation increased rapidly with the occurrence of infection (Almohammadi et al., 2022). Researchers Al-Ayed et al., (2019) assessed the risk factors linked to foot ulcers in type 2 DM patients in Saudi Arabia. After analyzing the study, it is known that foot ulceration patients face loss of protective sensation, lower limb abnormalities and deformity. The study’s findings recommended that regular foot examinations, wearing proper footwear, educating patients regarding foot ulcers, following basic cleanliness habits and prompt treatment for small injuries may prevent ulceration in diabetic patients (Al-Ayed et al., 2019). A study was done by researchers Fawzy et al., (2019) to investigate the factors linked to diabetic foot (DF) in Saudi Arabia due to the large burden of T2DM and its consequences. According to Fawzy et al., (2019), DF is one of the most serious consequences of diabetes, and DFU is widespread, affecting 15% of all diabetic individuals at some point in their lives. Diabetes-linked lower extremity amputation rates are key indicators for the efficacy of diabetes patients’ health treatment, including ulcer management and prevention and predicting the extent of the problem. DF illness is a serious health issue that reduces the patient’s life quality, costs a lot of money, and necessitates long hospital stays. Most amputations start with ulcers, which can be avoided with proper foot care and screening for foot complications (Fawzy et al., 2019). Studying Musa et al., (2018), it is known that a slower immunological response to infection and the prevalence of comorbidities that hinder healing are likely related to poorer outcomes as people get older. A longer diabetes period is linked to greater diabetic issues, like macrovascular problems, pivotal in ulcer persistence and skin breach (Musa et al., 2018).

Researchers Al Amri et al., (2021) tried to determine the degree of diabetic patients’ awareness of diabetic foot in Saudi Arabia’s Aseer region. The researchers tried to determine people’s attitudes towards diabetic foot care and how they implement it in their daily lives. According to Al Amri et al., (2021), DM’s one of the common consequences is the diabetic foot which affects around 50% of diabetic individuals accounting for around 80% of lower limb amputations. Diabetic foot is characterized by angiopathy and neuropathy that mainly affects the foot and results in tissue damage, ulceration and infection. The well-known risk factors for diabetic foot are peripheral vasculopathy, lengthy periods of uncontrolled diabetes, poor diabetic regulation, lack of general knowledge about diabetes, foot care to be specific, and older age. Reading Al Amri et al., (2021), it is known that DFU is the main reason for lower limb amputation in Saudi Arabia, and in the previous few years, in 49.6% of instances, it has been noticed that DFU has led to lower limb amputation. It is expected that the occurrence rates will continue to rise in the coming years. Diabetic foot affects 3.3% of diabetic individuals in Saudi Arabia, with 2.1% developing foot ulcers and 1.1% requiring amputation (Al Amri et al., 2021). Compared to other diabetic-related complications, diabetic foot issues are manageable. The study’s findings revealed that over two-thirds of diabetic individuals were informed about diabetic foot and its care (Al Amri et al., 2021). The people were aware of the effects of diabetes on feet, such as gangrene and ulcers, and the consequences of diabetes on foot blood flow and neuropathy related to loss of sensation. Young patients had greater knowledge levels due to their concern about diabetes-associated issues impacting their future lives. Diabetic individuals who could read and obtain information on their own and individuals having a family history of DM also had higher awareness levels (Al Amri et al., 2021).

Conclusion

Therefore, from the above discussion, it can be concluded that diabetes mellitus is a significant public health issue worldwide, especially in Saudi Arabia. DM has increased the risk factors of lower limb amputations, and it remains a major cause of death worldwide. The studies conducted by various researchers have revealed that diabetic foot disorders contribute significantly to limb amputations. It has been noticed that in diabetic foot disease, the ulcer was the common presentation. The analysis of the studies further revealed that amputations had impacted the psychological well being of the people and led to severe financial consequences. However, the studies also revealed that enhancing the life quality of the patients could reduce the management costs. Early detection, public education initiatives for raising awareness among people and proper foot cleanliness practices can restrict the incidence rates.

References

Al Amri, A. M., Shahrani, I. M., Almaker, Y. A., Alshehri, D. M., Argabi, M. A., Alghamidi, F. A., & Alqahtani, Y. Z. (2021). Knowledge, Attitude and Practice Regarding Risk of Diabetic Foot Among Diabetic Patients in Aseer Region, Saudi Arabia. Cureus, 13(10). https://www.cureus.com/articles/73794-knowledge-attitude-and-practice-regarding-risk-of-diabetic-foot-among-diabetic-patients-in-aseer-region-saudi-arabia

Al-Ayed, M. Y., Ababneh, M., Robert, A. A., Salman, A., Al Saeed, A., & Al Dawish, M. A. (2019). Evaluation of risk factors associated with diabetic foot ulcers in Saudi Arabia. Current diabetes reviews, 15(3), 224-232. https://doi.org/10.2174/1573399814666180816165848

Almohammadi, A. A., Alnashri, M. M., Harun, R. A. T., Alsamiri, S. M., & Alkhatieb, M. T. (2022). Pattern and type of amputation and mortality rate associated with diabetic foot in Jeddah, Saudi Arabia: A retrospective Cohort Study. Annals of Medicine and Surgery, 73, 103174. https://doi.org/10.1016/j.amsu.2021.103174

Al-Rubeaan, K., Almashouq, M. K., Youssef, A. M., Al-Qumaidi, H., Al Derwish, M., Ouizi, S., ... & Masoodi, S. N. (2017). All-cause mortality among diabetic foot patients and related risk factors in Saudi Arabia. PLoS One, 12(11), e0188097. https://doi.org/10.1371/journal.pone.0188097

Alshammary, S., Othman, S. A., Alshammari, E., Alarfaj, M. A., Lardhi, H. A., Amer, N. M., ... & Alghamdi, H. M. (2020). Economic impact of diabetic foot ulcers on healthcare in Saudi Arabia: a retrospective study. Annals of Saudi Medicine, 40(5), 425-435. https://doi.org/10.5144/0256-4947.2020.425

AlSofyani, M. A., AlHarthi, A. S., Farahat, F. M., & Abuznadah, W. T. (2016). Impact of rehabilitation programs on dependency and functional performance of patients with major lower limb amputations: a retrospective chart review in western Saudi Arabia. Saudi Medical Journal, 37(10), 1109. https://dx.doi.org/10.15537%2Fsmj.2016.10.16033

Fawzy, M. S., Alshammari, M. A., Alruwaili, A. A., Alanazi, R. T., Alharbi, J. A., Almasoud, A. M. R., ... & Toraih, E. A. (2019). Factors associated with diabetic foot among type 2 diabetes in Northern area of Saudi Arabia: a descriptive study. BMC Research Notes, 12(1), 1-7. https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-019-4088-4

Musa, I. R., Ahmed, M. O., Sabir, E. I., Alsheneber, I. F., Ibrahim, E. M., Mohamed, G. B., ... & Gasim, G. I. (2018). Factors associated with amputation among patients with diabetic foot ulcers in a Saudi population. BMC research notes, 11(1), 1-5. https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-018-3372-z.

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