Incidence of lower extremity amputation in the diabetic compared to the non-diabetic population: a systematic review protocol

Abstract

BackgroundDiabetic individuals have a largely increased risk of lower extremity amputation (LEA) compared with non-diabetic patients. Prior systematic reviews of incidence of LEA have some limitations with respect to lack of consensus in the definition of LEA, level of LEA (all, major, minor), and definition of source population (general population or population with diabetes at risk). The purpose of our review is to evaluate the incidence of LEA in the diabetic population and its differences with regard to sex, ethnicity, age, and regions; to compare the incidence rate (IR) in the diabetic and non-diabetic population; and to investigate time trends.Methods/designWe will perform a systematic literature search in MEDLINE, Embase, Web of Knowledge, and publisher databases such as Journals@OVID and ScienceDirect. We will develop comprehensive systematic search strategies according to established guidelines for meta-analyses of observational studies in epidemiology (the MOOSE group). Two authors will independently screen abstracts and full text of all references on the basis of inclusion criteria with respect to types of study, types of population, and the main outcome. We will exclude studies if they report solely incidences of LEA among persons with diabetes mellitus when referring to the total population (diabetic and non-diabetic) and not exclusively to the diabetic population. Data extraction and assessment of risk of bias will be undertaken by two review authors working independently. We will assess incidence rate (IR) or cumulative incidence (CumI), relative risk of amputations comparing the diabetic to non-diabetic populations, cause of LEA, and type of diabetes. If we find subsets of studies to be homogeneous enough, we will perform meta-analyses for incidence rates by Poisson generalized linear mixed models (GLMM).Systematic review registrationPROSPERO CRD42015017809Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0064-9) contains supplementary material, which is available to authorized users.

Evaluation of negative-pressure wound therapy for patients with diabetic foot ulcers: systematic review and meta-analysis

“…As a consequence of DFUs, a lower limb is lost every 30 seconds somewhere in the world, and the probability of losing the other leg is 50% after 3 years. DFUs contribute to 85% of non-traumatic, lower-extremity amputations and lead to a 13%–17% mortality rate in patients with DM 4,5. In comparison to non-DFU patients, DFU patients have more days of hospitalization and more days requiring home health care, emergency department visits, and outpatient/physician office visits 6.…”

Incidence of lower limb amputation in Canada

“…Therefore, depending on how the cases are defined and counted, the results can differ notably from study to study. According to a protocol of a systematic review by Kvitkina et al 21 on diabetes-related incidence rates, there are three methods for counting the number of LLA cases and therefore determining the numerator: 1) person-level: when only one amputation per person is counted; 2) case-level: when only one amputation per limb on the same admission is counted but amputations on different admissions are counted separately; and 3) procedurallevel: when all amputation procedures regardless of whether carried out at the same or different admissions are counted separately. In this study, we chose to report the data based on case level because it was compatible with the incidence studies that had clear methods.…”

Advantages of Negative Pressure Therapy in Local Diabetic Foot Treatment

“…Research has shown that the presence of foot lesions is a predictive mortality factor for the diabetic patient even at 10 years [19]. The diabetic foot generates 85% of amputations without a traumatic cause and corresponds to a mortality rate of 13-15% among diabetics [22]. The number of diabetic foot amputations has been steadily increasing and may be considered an indicator of the effectiveness of multidisciplinar y diabetic foot management.…”