Diabetes mellitus (DM) is a common metabolic disorder in the tropics. Its vascular and neurologic complications are seen mainly in adults, usually involving the lower limbs to cause foot ulcers. Hand ulcer/infection is an uncommon complication, and reports are scanty in Nigeria.
The study was to ascertain the prevalence, predisposing factors and outcome of hand ulcers among diabetics in our environment.
A prospective study of diabetic patients admitted into the medical wards of the University of Port Harcourt Teaching Hospital (UPTH), Rivers State, Southern Nigeria between January 2001 and April 2002 (16 months) was done. The patients' demographic indices, details of duration of diabetes and history of evolution of hand ulcer as well as evidence of peripheral neuropathy and vascular disease were assessed. Fasting blood glucose estimation was done on admission, and deep wound swabs were obtained for standard microbiological analysis.
Five (1.6%) patients had hand ulcers, with a mean age of 42 years. This gave an incidence of >2 cases/year. There were three females and two males. Minor domestic trauma, application of local herbs to an existing wound, and delayed presentation to the hospital were predisposing factors for the development of hand ulcer/infection. Low socioeconomic class, with poor glycaemic control was also a risk factor. Microorganisms were isolated in all the ulcers, with staphylococcus aureus being the commonest organism. Death occurred in one patient, giving a mortality rate of 20%. The mortality was associated with prolonged hospitalization and amputation of the digit.
Hand ulcer/infection is an increasing cause of morbidity and mortality among adult diabetics in our hospital. It followed trivial trauma in poorly controlled DM, and is worsened by application of local herbs, self-treatment and late presentation to hospital.
Diabetes mellitus, Hand ulcers
