Tropical diabetic hand syndrome: risk factors in an adult diabetes population.
OBJECTIVE
To determine risk factors for the tropical diabetic hand syndrome, a condition associated with significant morbidity and mortality in Africa.


METHODS
This was a case-control study of a Tanzanian diabetes population presenting with the syndrome during February 1998 to March 2000. A case patient was defined as any patient with diabetes presenting with hand cellulitis, ulceration, or gangrene. Control patients were randomly selected patients with diabetes who had no hand symptoms.


RESULTS
Thirty-one case patients and 96 control patients were identified. The median age of case patients was 52 years (range, 28--76 y); 58% were male; 4 patients (16%) died. Precipitating events included papule (n = 6), insect bites (n = 6), boils (n = 5), burns (n = 2), or trauma (n = 3). Case and control patients were similar for presence of micro- and macrovascular disease and occupation. On logistic regression analysis, independent risk factors were body mass index of 20 or less (odds ratio [OR] = 18.0; 95% confidence interval [CI] = 4.3--97.0; P < 0.001), peripheral neuropathy (OR = 23.0; 95% CI = 5.3--124.0; P < 0.001), or type I diabetes, (OR = 6.7; 95% CI = 2.0--24.0, P < 0.01).


CONCLUSIONS
The major risk factors for the tropical diabetic hand syndrome are intrinsically related to the underlying disease. Thus, prevention of hand infections may require aggressive glucose control, and education on hand care and the importance of seeing a doctor promptly at the onset of symptoms.
Abbas
Z G
ZG
Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania. zabbas@muchs.ac.tz
Lutale
J
J
Gill
G V
GV
Archibald
L K
LK
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D002481:Cellulitis / Q000150:complications / Q000209:etiology; D003925:Diabetic Angiopathies / Q000150:complications* / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D004198:Disease Susceptibility; D005260:Female; D005734:Gangrene / Q000150:complications / Q000209:etiology*; D006225:Hand / Q000473:pathology*; D006801:Humans; D007328:Insulin / Q000494:pharmacology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018805:Sepsis / Q000150:complications / Q000209:etiology; D013577:Syndrome; D013636:Tanzania / Q000453:epidemiology; D014456:Ulcer / Q000150:complications / Q000209:etiology*
D007328:Insulin