Lower-Extremity Amputation in People With Diabetes: Epidemiology and Prevention

Abstract

The age-adjusted rate of lower-extremity amputation (LEA) in the diabetic population is approximately 15 times that of the nondiabetic population. Over 50,000 LEAs were performed on individuals with diabetes in the United States in 1985. Among individuals with diabetes, peripheral neuropathy and peripheral vascular disease (PVD) are major predisposing factors for LEA. Lack of adequate foot care and infection are additional risk factors. Several large clinical centers have experienced a 44-85% reduction in the rate of amputations among individuals with diabetes after the implementation of improved foot-care programs. Programs to reduce amputations among people with diabetes in primary-care settings should identify those at high risk; clinically evaluate individuals to determine specific risk status; ensure appropriate preventive therapy, treatment for foot problems, and follow-up; provide patient education; and, when necessary, refer patients to specialists, including health-care professionals for diagnostic and therapeutic interventions and shoe fitters for proper footwear. Programs should monitor and evaluate their activities and outcomes. Many issues related to the etiology and prevention of LEAs require further research.

Non-traumatic lower limb amputation in patients with end-stage renal failure on dialysis: an Australian perspective

“…There should be sufficient opportunities taken by the health care provider to do regular foot checks for this patient population as such activities have proven to be beneficial in limb salvation. 44 In summary, this current study reports a high prevalence of LLA in Australia's North Queensland patients with ESRF on dialysis. The LLA occurred predominantly amongst indigenous Australians.…”

“…Along with low serum albumin levels and high CRP, we found higher HbA1c levels to be associated with LLAs, suggesting, uncontrolled DM as a risk factor. 44 As previously discussed that DM predisposes to micro-and macro-vascular complications, development of diabetic foot syndrome and also infections, 2,3 it would be ideal for these patients to have a tighter control of their blood sugar levels hence preventing worsening prognosis of foot complications which require LLAs. Our findings are consistent with other studies done previously; Plantinga et al 21 and Ishii et al 16 also found the association between high CRP levels while Plantinga et al's study along with Speckman et al 24 also reported the low levels of albumin amongst amputees, while LockingCustolito et al 17 found that elevated HbA1c was associated with LLAs.…”

Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus

“…77,83 Evidence indicates that early detection of diabetic neuropathy results in fewer admissions for foot ulcers and amputations. 84 As shown in Figure 4, sensory testing with nylon monofilament (10 g) should be done regularly to identify sensory loss at appropriate anatomic landmarks of the foot. 85 The optimum interval between such examinations has not been determined, but many experts advise annual testing.…”

Pé diabético: estratégias para prevenção

“…As lesões geralmente decorrem de trauma e freqüente-mente se complicam com gangrena e infecção, ocasionadas por falhas no processo de cicatrização (2)(3)(4) as quais podem resultar em amputação, quando não se institui tratamento precoce e adequado (1) . Cinqüenta por cento das amputações não-traumáticas de membros inferiores são atribuídas ao diabetes (2,(5)(6) e o risco de amputação é 15 vezes maior do que na população geral (7) . Três anos após amputação de um membro inferior, a porcentagem de sobrevida do indivíduo é de 50%, enquanto, no prazo de cinco anos, a taxa de mortalidade permanece de 39% a 68% (8) .…”