Factors predicting lower extremity amputations in patients with type 1 or type 2 diabetes mellitus: a population‐based 7‐year follow‐up study

Abstract

Abstract. Ha Èma Èla Èinen H, Ro Ènnemaa T, Halonen J-P, Toikka T (Social Insurance Institution, Turku; University of Turku, Finland). Factors predicting lower extremity amputations in patients with type 1 or type 2 diabetes mellitus: a population-based 7-year follow-up study. J Intern Med 1999; 246: 97± 103.Objectives. The aim of the study was to find factors predicting lower extremity amputation in patients with type 1 or type 2 diabetes mellitus through a 7-year follow-up period. Design. Follow-up study. Subjects. Altogether 733 diabetic patients, aged 10±79 years, were drawn from the national drug reimbursement register. Methods. At baseline, the patients underwent a podiatric, circulatory and neurophysiological examination. Seven years later a follow-up study was performed based on clinical and register data. Patient data for those who died during the followup were collected from hospital records and death certificates. All amputations were recorded. The patients with amputation were compared with the other patients and also, in a case-control manner, by taking three nonamputated patients matched by sex, type of diabetes, and age for each patient with amputation.Results. The number of amputations was 25 in the sample. Compared with all patients without amputation, patients with amputation differed in altogether 24 variables concerning diabetes and its complications. Compared with the matched nonamputated patients, the amputated patients had longer duration of diabetes, lower ankle/brachial pressure index (ABI), more often history of retinopathy, nephropathy, and hypertension, more often visual handicap, elevated serum creatinine level, abnormal neurophysiological indices and electrophysiological findings. In the logistic regression analysis, vibration perception threshold, low ABI, history of retinopathy, visual handicap, and male sex were independently associated with lower extremity amputation. Conclusions. Lower extremity amputations were strongly associated with retinopathy, nephropathy, and neuropathy. The presence of any of these complications should lead to intensified actions in order to prevent amputations. As far as arterial circulation is concerned, claudication or absent peripheral pulses were not good predictors of amputation, whereas low ABI, despite its known weaknesses, was a reliable indicator of future amputation.

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.…”

Diabetic Foot Ulcer: A Review

“…These includes insensitivity to 10g monofilament, decrease motor nerve conduction velocity of the deep peroneal nerve and sensory nerve conduction velocity of the sural nerve, VPT, absent or diminished bilateral vibration sensation, and absent Achilles tendon and patellar reflexes. Table 07 shows the studies that reported a statistically significant association between one or more measures of peripheral neuropathy and amputation [48,51,[55][56][57][58][59][60]. While some did not show any association with the amputation and peripheral neuropathy [46,48,61,62].…”

“…The peripheral arterial function, as measured by absent or diminished dorsal pedis and posterior tibialis pulses as well as median arterial calcification and its relationship to amputations, is an independent risk factors to predict the amputation in diabetic patients with foot ulcer [48,51,54,55,57,59,60,62]. High blood pressure is also an independent predictive risk factor for amputation in various studies [46,56,61].…”

Diabetic Foot Amputation; Frequency of Diabetic Nephropathy Among Patients

“…18 Other studies have also found nephropathy to be a significant prognostic factor. 19,20,21 However, some investigators have disputed the predictive role of nephropathy. 22,23 Advanced glycation end-products have been implicated in diabetic complications, and in nephropathy patients, their concentrations are high resulting in induction of proteinuria.…”