Lower extremity amputations due to diabetes; risk factors for reamputations and the role of imaging methods in determining the level of amputation

Korkmaz, İzzet; Bingöl, Olgun; Karlidag, Taner; Keskin, Ömer Halit; Kılıç, Enver; Özdemir, Güzelali

doi:10.1016/j.deman.2021.100036

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…Consistently, the topical data also showed that use of insulin therapy is protective against amputations. Insulin is associated with inflammation reduction, revascularization and wound healing, thereby acting as a protective factor against diabetes-related complications and amputations, in concordance with the topical data [ 39 , 40 ]. However, for PLWD in Zimbabwe, there can be a disrupted supply chain of essential medications, such as insulin, which can impede adherence, and can be exacerbated for people who have lived with diabetes for longer [ 4 , 16 , 41 ].…”

Section: Discussionsupporting

confidence: 75%

Prevalence and risk factors for diabetic foot complications among people living with diabetes in Harare, Zimbabwe: a cross-sectional study

Kuguyo,

Mukona,

Chikwasha

et al. 2024

BMC Public Health

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Background Diabetic foot disease (DF) is a common diabetes-related complication; however, the prevalence and associated risk factors for DF are not well characterised among people living with diabetes (PLWD) in Zimbabwe. This may suggest the unavailability of adequate strategies to diagnose and treat DF in the country. This study aimed to determine the prevalence of DF and associated risk factors for PLWD in Harare, Zimbabwe. Methods This was a cross-sectional study, employing a quantitative approach. In total, 352 PLWD were recruited from 16 primary care clinics in Harare. Sociodemographic and clinical data were collected via face-to-face interviews and clinical records reviews. The DF screening included an evaluation for peripheral neuropathy, ankle-brachial index (ABI), ulceration, and amputation. Self-administered questionnaires were used to assess knowledge, attitudes, and practices (KAPs), and KAP was scored using Bloom’s cut-off. Chi-Square goodness-of-fit tests were performed, and regression analyses were used for association analysis. The threshold for significance was p < 0.05. Results This group included 82 men and 279 women, with a combined mean age of 57.9 ± 14 years. Twenty one (~ 26%) men and 41 (15%) women had type 1 diabetes. The diabetes type distribution significantly differed by gender (p < 0.001). Oral hypoglycaemics (71%) were most commonly administered for management. DF was observed in 53% (95% CI = 50–56) of PLWD. Other DF symptoms observed were abnormal ABI (53%), peripheral neuropathy (53%), foot ulceration (17%) and amputation (3%). Peripheral neuropathy increased the risk of ulceration (OR = 1.7; 95% CI = 1.1–2.6; p = 0.019), while insulin use was protective against amputation (OR = 0.1; 95% CI = 0.1–0.9; p = 0.049). Most (87%) of the participants demonstrated good DF knowledge and the importance of adhering to medication to prevent DF. However, 96% did not know that smoking was a risk factor for DF. Nearly two-thirds (63%) demonstrated poor attitudes and practices. Poor attitudes and practices were not predictors of DF ulceration risk (p > 0.05). Conclusion This study showed that there was a high prevalence of DF (53%) in PLWD in Zimbabwe, and insulin use was protective against DF. There is an urgent need for policy revisions to include foot screening in routine primary care and increasing insulin use for PLWD to prevent complications such as DF as an integral part of primary care.

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Section: Discussionsupporting

confidence: 75%

Prevalence and risk factors for diabetic foot complications among people living with diabetes in Harare, Zimbabwe: a cross-sectional study

Kuguyo,

Mukona,

Chikwasha

et al. 2024

BMC Public Health

View full text Add to dashboard Cite

show abstract

“…Consistently, the topical data also showed that adherence to insulin therapy is protective against amputations. Insulin is associated with in ammation reduction, revascularization and wound healing, thereby acting as a protective factor against diabetes-related complications and amputations, in concordance with the topical data (39,40). However, for PLWD in Zimbabwe, there can be a disrupted supply chain of essential medications, such as insulin, which can impede adherence, and can be exacerbated for people who have lived with diabetes for longer (4,16,41).…”

Section: Discussionmentioning

confidence: 73%

Prevalence and risk factors for diabetic foot complications among people living with diabetes in Harare, Zimbabwe

Kuguyo,

Mukona,

Chikwasha

et al. 2023

Preprint

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Background Diabetic foot (DF) is one of the most common diabetes-related complications, however, the prevalence and associated risk factors of DF are not well characterized among people living with diabetes (PLWD) in Zimbabwe. This study aims to determine the prevalence of diabetic foot and associated risk factors in PLWD in Zimbabwe. Methods This was a cross-sectional study, employing a mixed-methods approach was used to obtain data. A total of 352 PLWD were recruited from 16 primary care clinics across Harare. Face-to-face interviews and patient record reviews were used to collect sociodemographic and clinical data. Screening for DF included sole pressure, peripheral neuropathy, ankle-brachial index, deep tendon reflexes, ulceration, and amputation were performed. Self-administered questionnaires were used to assess knowledge, attitudes, and practices (KAPs). Scoring for KAPs was done using Bloom’s cutoff, and regression analyses were used to associate variables with DF risk. Results This group was made up of 82 men and 279 women. The combined mean age was 57.9 ± 14 years, and the age was comparable by gender (p > 0.05). More than a quarter (n = 21) of men and 15% (n = 41) ofwomen had Type 1 diabetes. The distribution of diabetes type significantly differed by gender (p < 0.001). DF was observed in 53% of PLWD. Abnormal ankle-brachial index (53%) and peripheral neuropathy (53%), foot ulceration (17%) and amputations (3%) were observed. Peripheral neuropathy increased the risk of ulceration (OR = 1.7; 95% CI = 1.1–2.6; p = 0.019), while insulin adherence was protective against amputation (OR = 0.1; 95% CI = 0.1–0.9; p = 0.049). Most (87%) of the group demonstrated good DF knowledge and the importance of adhering to medication to prevent DF. However, 96% did not know that smoking was a risk of DF. Nearly two-thirds (63%) of the group demonstrated poor attitudes and practices. Poor attitudes and practices were not predictors of diabetic foot ulceration risk (p > 0.05). Conclusion Our findings report a high prevalence of DF (53%) in PLWD in Zimbabwe. However, DF is not routinely assessed in Zimbabwe. Adherence to insulin was found to protect against DF, underscoring the need for policy revisions to include screening and increasing insulin adherence to prevent DF as integral primary care for PLWD.

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Analysis of systemic risk factors between diabetic/vascular patients having primary lower limb amputations and re-amputations

et al. 2023

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Background: Patients with diabetes mellitus (DM) are known to be predisposed to many complications in the lower extremities such as neuropathy, peripheral artery disease (PAD) and infection. Diabetic foot ulcers are complications of diabetes that can lead to lower extremity amputations, re-amputations and high mortality rates. Purpose: The aim of this study is to evaluate the risk factors associated with higher re-amputation rates in diabetic foot disease. Research Design: This is a mono-centric retrospective comparative study. Study Sample: the study included 136 patients, with a total of 193 procedures (111 primary amputations and 82 re-amputations) between 2011 and 2021. Data Analysis: The t-student test and Spearman correlation were used to look for mean differences and any relevant association, respectively. Multivariate logistic regression analysis was computed to look for independent variables. Results: Twenty-two (27%) and 60 (50%) of those who had major and minor amputations, respectively, had a re-amputation ( p = 0.006). Besides diabetes (89%), the commonest risk factor associated with amputation was hypertension (86.7%), be it for primary amputation or re-amputation, followed by peripheral (PAD) and coronary artery diseases. Only three risk factors showed independent correlation with re-amputation; chronic kidney disease (r = 15%, p = 0.03), smoking (r = 15%, p = 0.03), and simultaneous presence of DM + PAD (r = 13.7%, p = 0.05). Conclusions: Factors that were significantly correlated with increased re-amputation rates have a clear pathologic pathway that affects vascularity and wound healing. Further studies should be aimed at developing a clear scoring system that can be used to stratify patient for re-amputation risk, and to better predict the results according to the severity of diabetes.

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Lower extremity amputations due to diabetes; risk factors for reamputations and the role of imaging methods in determining the level of amputation

Cited by 3 publications

References 23 publications

Prevalence and risk factors for diabetic foot complications among people living with diabetes in Harare, Zimbabwe: a cross-sectional study

Prevalence and risk factors for diabetic foot complications among people living with diabetes in Harare, Zimbabwe: a cross-sectional study

Prevalence and risk factors for diabetic foot complications among people living with diabetes in Harare, Zimbabwe

Analysis of systemic risk factors between diabetic/vascular patients having primary lower limb amputations and re-amputations

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