Demographic and socioeconomic profiles of patients admitted with diabetic foot complications in a tertiary hospital in Belem – Para

Objective: to assess the socioeconomic and demographic profiles of patients hospitalized with a diagnosis of diabetic foot in a tertiary hospital in Belem-PA, Brazil, as well as to evaluate risk factors for lower limb amputations in such patients, classifying them according to the Wagner and PEDIS classifications. Methods: we conducted a descriptive, cross-sectional, unicentric, and analytical study carried out through a structured questionnaire. Results: the study consisted of 57 patients, aged between 48 and 84 years old, 66.7% being male. The average income ranged between one and three (61.4%) minimum wages and below one minimum wage (31.6%). Type II Diabetes Mellitus was predominant (86.0%). Concerning comorbidities, arterial hypertension displayed the highest proportion (62.3%), followed by dyslipidemia (52.8%). Smokers comprised 35.1% of the sample. Infectious diabetic foot (50.9%) and mixed diabetic foot (49.1%) were the most common. Of the 20 patients with previous amputation, 90% had undergone minor amputation, and 10%, major ones. Callosity (92.6%) was the most prevalent deformity. Fifty-four (94.7%) patients underwent surgery, those being debridement (24.1%), minor amputation (37.0%) and major amputation (38.9%). During hospitalization, 78.9% of individuals did not require ICU stay. Hospitalization time varied between three and 59 days, and 78.9% of hospitalized patients did not progress to death, but 43.1% of patients submitted to major amputations died. Conclusion: patients with diabetic foot followed-up have a low socioeconomic profile; most of them underwent surgical procedures, whether major or minor, due to the higher prevalence of infectious diabetic foot and/or non-adherence to non-operative treatment.


INTRODUCTION
Diabetes mellitus (DM) is a chronic metabolic disease with persistent hyperglycemia, caused by hereditary and environmental factors, resulting from defects in the secretion or action of insulin, or both 1,2,3 . The disease can be classified into type 1 DM, with autoimmune origin, resulting from the destruction of pancreatic β-cells that causes complete insulin deficiency, and type 2 DM, characterized by insulin resistance 2,3 .
According to the International Diabetes The main diabetes complications are due to micro and macrovascular changes, which result in retinopathy, nephropathy, neuropathy, and coronary, cerebrovascular, and peripheral arterial diseases 2 . We performed descriptive and analytical statistics with the BioEstat ® 5.4 software. For decisionmaking, we adopted the significance level α = 0.05, or 5%, signaling the significant values with an asterisk (*).

RESULTS
The study sample consisted of 57 patients, with a mean age of 63.2 years, a statistically significant proportion of male patients, married, retired, and coming from the metropolitan region.  Table 2. Table 3 illustrates the distribution of patients according to the presence of comorbidities.

Reis
Demographic and socioeconomic profiles of patients admitted with diabetic foot complications in a tertiary hospital in Belem -Para    The majority of amputations classified as minor were of the foot (60.0%), followed by toes (40.0%).
Among those classified as major amputations, the majority were of the leg (61.9%), followed by the thigh (38.1%), as recorded in Table 5.

Reis
Demographic and socioeconomic profiles of patients admitted with diabetic foot complications in a tertiary hospital in Belem -Para the grouping ranges.
Twelve patients died during hospitalization (21.1%) with a statistically significant predominance in cases undergoing major amputation (38.1%, p = 0.0252).    Also, 75.9% of patients progress to some type of amputation, with 37% minor amputation, and 38.9%, major 12,15 . Even though no significant differences were observed in the various studies on the global incidence of amputations in diabetics, this is a high number comparing with those reported by international studies, which show rates between 11% and 29% 12 .
Admission to the intensive care unit (ICU) was necessary in 21.1% of the patients. Hospitalization time ranged between three and 59 days, with an average of 20 days. Time greater than that was found in two national studies: 9% in Tavares et al. 16 and 14% by Borboletto et al. 6 , which may be justified by the clinical conditions on the patients' admission, as well as complications related to the delay in hospitalization 4,16-18 .
The mortality percentage was 21.1%, which is similar to that described by Oliveira et al.,19% 15 . In the group of amputees, mortality was 43.1%, above the average of most national studies (38.1% for major amputation and 5% for minor) 15 . This illustrates that a significant number of patients evolve with the most serious complications of the diabetic foot, mainly due to the delay in hospital admission 19 . This aspect is related to living outside the metropolitan region, where most services do not have specialized vascular care coverage.
There are several scores to determine the severity of the diabetic ulcers [19][20]

CONCLUSION
The present study revealed that at the HUJBB, in Belem-Para, the profile of occurrence of diabetic foot was higher in male patients, over 50 years of age. Lowincome patients with little education predominated, with type II diabetes and an infectious foot pattern.
The cases were admitted with more advanced Wagner and PEDIS classifications, which correlated with high rates of amputations, impacting mortality.