Diabetes Mellitus-related Foot Surgeries in the Republic of the Marshall Islands in Micronesia.

Abstract

Diabetes Mellitus (DM) is the leading cause of morbidity and mortality in the Republic of the Marshall Islands (RMI), a small Pacific nation located in Micronesia (population 53,184). Although generally preventable, diabetic foot disease is among the most frequently reported complication of DM globally and in the RMI. Over 25% of people with DM globally will have at least one DM-related foot ulcer, which may require surgical intervention. The purpose of this study is to determine the incidence of DM-related foot surgeries at the Leroij Atama Zedkaia Majuro Hospital, the main tertiary referral centre for the RMI, and where 90% of all DM-related foot surgeries in the country are conducted. A retrospective review of surgical and clinical records at Majuro Hospital for the 12-month period January 2015 to December 2015 was conducted to determine the incidence and characteristics of DM-related foot surgeries (foot ulcer debridement or lower limb amputation [LLA]). DM-related foot surgery was the fourth most common surgical procedure conducted in the RMI during the 12-month period reviewed. Four percent of people with DM presenting to the Majuro Hospital during the review period required DM-related foot surgery. The incidence of DM-related major LLAs was 103 per 100,000 population. As age increased, so did the proportion of patients requiring DM-related foot surgery. Eighty six percent of those requiring surgery were 50 years and older, and the majority were male (54.6%). The incidence of DM-related foot surgeries in the RMI remains high by international standards. The study findings confirm the need to address the burden of DM in the RMI and support the country's NCD Crisis Action Plan.