Clinical outcomes of toe amputation in patients with type 2 diabetes in Tianjin, China

Abstract

The aim of this study is to determine the predictors for reulceration, reamputation and mortality in patients with diabetes following toe amputation, and the impact of activities of daily living on clinical outcomes. This prospective cohort study included 245 patients who had undergone toe amputation (202 healing and 43 non-healing) and was followed for a 5-year period. Data regarding new foot ulceration, reamputation and mortality were recorded, and the patients' activities of daily living were evaluated. The rate of wound healing was 82·4%. The rate of follow-up in the healed group was 91·6%. In years 1, 3 and 5, the cumulative incidence of patients who developed a new foot ulcer was 27·3%, 57·2% and 76·4%, respectively, leading to reamputation in 12·5%, 22·3% and 47·1%, respectively. The cumulative mortality was 5·8%, 15·1% and 32·7% at 1, 3 and 5 years, respectively. Multivariate analysis showed that GHbA1c > 9% (75 mmol/mol) was identified as an independent predictor of impaired wound healing, reulceration and reamputation. An age of >70 years was identified as an independent predictor of reamputation, mortality and impairment of activities of daily living. Despite a satisfactory initial healing rate after the first toe amputation, with the extension course after the toe amputation, the long-term outcomes are not optimistic. In developing countries like China, taking measures to prevent reulceration and reamputation is very important for patients with diabetic foot minor amputations, especially following toe amputation.

Risk factors for mortality in patients with diabetic foot infections: a prospective cohort study

“…Older age was a risk factor for mortality on multivariable analysis. Increased mortality with age has been previously reported among patients with diabetic foot ulceration – after toe amputation for a diabetic foot – and in patients with DFI in the context of chronic kidney disease . Increased age‐related comorbidities may play a role, as may the recognised poorer outcomes after amputation in the elderly .…”

“…Increased mortality with age has been previously reported among patients with diabetic foot ulcerationafter toe amputation for a diabetic footand in patients with DFI in the context of chronic kidney disease. 14,20,21 Increased age-related comorbidities may play a role, as may the recognised poorer outcomes after amputation in the elderly. 21,22 In our study, only two (0.5%) patients had major amputation as their initial procedure, and only 11 (2.7%) had a previous major amputation, limiting any conclusion that may have been drawn regarding outcomes after previous or initial major amputation level.…”

Foot Care Practices among Type 2 Diabetics Mellitus Patients Attending Diabetes Clinics in Embu County, Kenya

“…There are many complications that affect people with diabetes, the foot ulcer complications take lead [9]. According to Chu and Wang [10], some patients developed foot ulcer after 1, 3, and 5 years and when their prevalence was examined they were increasing from 27.3%, 57.2%, and 76.4%, respectively, this also led to increase in prevalence of foot amputations at 12.5%, 22.3%, and 47.1% respectively [10]. Other studies showed that the mortality rate as a result of diabetic foot amputation ranges from 13% to 40% within one year, at 3 years it was ranging from 35% to 65%, and at 5 years it was ranging from 39% to 80%, which was found to be worse than the mortality rate for most cancers [11].…”

Validation of an algorithm to predict reulceration in amputation patients with diabetes

“…Both single and multiple toe amputation lead to deformities and alter foot function, increasing the risk of development of new ulceration . Although location and level of amputation have been also related to high probability of reulceration , until recently , there has been no proposal of a simple algorithm that embraces all variables.…”

“…Both single and multiple toe amputation lead to deformities and alter foot function, increasing the risk of development of new ulceration (5,6). Although location and level of amputation have been also related to high probability of reulceration (7)(8)(9)(10), until recently (11), there has Key Message • transfer lesions are a common situation after minor amputation that may be extremity or life-threatening, increasing the health care cost • this is an assessment of reulceration risk using Miller's formula in 156 consecutive records of participants with diabetes and a history of amputation • one amputation more than first segment amputation shows the highest risk of reulceration between patients with previous forefoot amputations been no proposal of a simple algorithm that embraces all variables. Miller et al (11) distinguished between patients who have undergone one or more forefoot amputations, those who had an appropriate foot function and a low likelihood of reulceration and those who will probably develop a new ulcer and will undergo revisional surgery.…”