Effects of Ethnicity and Nephropathy on Lower-Extremity Amputation Risk Among Diabetic Veterans

Abstract

OBJECTIVE -To describe ethnic differences in the risk of amputation in diabetic patients with diabetic nephropathy. RESEARCH DESIGN AND METHODS-A retrospective cohort study was conducted on a national cohort of diabetic patients who received primary care within the Veterans Affairs (VA) Health Care System. Hospitalizations for lower-limb amputations were established by ICD-9-CM procedure codes. Relative risk of amputation in diabetic patients with and without diabetic nephropathy was determined using Cox proportional hazard modeling for unadjusted and adjusted models.RESULTS -Of the 429,918 subjects identified with diabetes (mean age 64 Ϯ 11 years, 97.4% male), 3,289 individuals were determined to have had a lower-limb amputation during the study period. Compared with diabetic patients without amputations, amputees were on average older, more likely to belong to a minority group, and were more likely to have received treatment for more comorbid conditions. Asians were more likely to have toe amputations compared with whites or other ethnicities, while Native Americans were more likely to have below-the-knee amputations. Native Americans had the highest risk of amputation (RR 1.74, 95% CI 1.39 -2.18), followed by African Americans (RR 1.41, 95% CI 1.34 -1.48) and Hispanics (RR 1.28, 95% CI 1.20 -1.38) compared with whites. The presence of diabetic nephropathy increased the risk of amputation threefold in all groups. Asian subjects with diabetes had the lowest adjusted relative risk of amputation (RR 0.31, 95% CI 0.19 -0.50).CONCLUSIONS -Among diabetic patients, certain ethnic minority individuals have an increased risk of lower-extremity amputation compared with whites. Presence of diabetic nephropathy further increases this risk. Diabetes Care 26:495-501, 2003

Smoking increases the risk of diabetic foot amputation: A meta-analysis

“…A notable amount of literature exists on risk factors for amputation among patients with diabetes. A number of risk factors have been reported, including age (31,32), gender (33,34), ischemic heart disease (31), hypertension (31), peripheral artery disease (35), nephropathy (36), duration of diabetes (37) and hemoglobin A1C (38,39). However, there are inconsistencies among studies regarding smoking as a risk factor for diabetic foot amputation.…”

Depression and Risk of Hospitalizations for Ambulatory Care-Sensitive Conditions in Patients with Diabetes

“…1 Among adults ages 65 or older, eight in ten may either have diabetes or prediabetes. 2 Diabetes is known to account for substantial morbidity, disability and mortality, [2][3][4][5] and is also a major driver of exploding healthcare costs. 6 Hospitalization costs are responsible for approximately 50 % of all healthcare costs attributable to diabetes.…”

Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care

“…Black patients with diabetes are less likely than white patients to receive appropriate hemoglobin A1c and lipid testing 1,2 and less likely to achieve treatment goals including glycemic, cholesterol, and blood pressure control. [3][4][5][6][7][8] Blacks also experience worse long-term diabetes-related outcomes than whites, including diabetic retinopathy, 9 lower extremity amputations, 2,10,11 and chronic kidney disease. 12 Hispanics and Native Americans have also been found to receive lower-quality diabetes care, with Native Americans experiencing disproportionately high rates of lower extremity amputations, chronic kidney disease, and diabetes-related mortality.…”