Prevalence of lower-extremity amputation among patients with diabetes mellitus: Is height a factor?

Tseng, Chin‐Hsiao

doi:10.1503/cmaj.050680

Cited by 49 publications

(62 citation statements)

References 13 publications

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“…As per the definition of PIN which has been described in the methods section, 9.1% of the subjects had PIN. It was less in comparison to that in other studies (16.2%) (Cheng YJ et al,) [1], which was probably due to the differences in the race and ethnicity (Abbott CA et al,) [13].The reason for the difference in the rates between the ethnic groups is unknown, but height may be a factor (Tseng et al, [14], Abbott CA et al, [13], as is also BMI (Tseng et al,) [14].…”

Section: Discussionmentioning

confidence: 71%

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Peripheral Insensate Neuropathy- Is Height a Risk Factor?

Kote

Bhat²,

Thajuddeen

et al. 2013

JCDR

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Introduction: Peripheral insensate neuropathy is one of the most commonest and the earliest forms of peripheral neuropathy. It is one of the leading causes of the disability in working population who are at risk. Methods:A study was conducted in Kasturba medical college (Manipal university) in the year 2009-12, which included examination of 818 people of more than 30yrs of age by random sampling method who were attending the outpatient clinic. A monofilament was used to determine the peripheral insensate neuropathy, which was defined by the presence of one or more insensate areas. Results:In our study , the prevalence of peripheral insensate neuropathy was 16.2 % ( p-0.0001), among which 9.7% were males and 7.5% were females. The males were 1.27 times significantly at a higher risk than the females , even after a height adjustment to the gender difference in height. As the height increased, the prevalence of peripheral insensate neuropathy increased, irrespective of the diabetic and hypertensive statuses. The risk of the peripheral insensate neuropathy increases at a height of >167 cm in males and at a height of >159 cm in females. Conclusion:The authors conclude that body height is an important and an independent risk factor for peripheral insensate neuropathy, irrespective of co morbidities. Height as a marker, helps the health care professionals in identifying the people who are at risk for peripheral insensate neuropathy.G S Sharath Kote, ajay N Bhat, thajuddeeN K, MohaMMed h ISMaIl, aBhISheK Gupta InTROduCTIOnPeripheral insensate neuropathy is defined as the presence of one or more insensate areas [1]. It is a common problem which is encountered in middle and old aged people. It is one of the disabling complications of diabetes because of its high incidence and its potential to lead to lower extremity ulceration, deformation and amputation [2]. Many factors have been associated with neuropathy, like age, sex, race, glycaemic control, nutrition, toxin exposure, drugs, alcohol, etc [1,3,4].Peripheral neuropathy affects 2-8% of the adults and it increases with age. With an early detection and history taking and focused laboratory tests, the underlying cause can be identified in ~75% of the cases. The prevalence of neuropathy is 66% for type 1 diabetes and it is 59% for type 2 diabetes. In a population cohort of diabetic patients, two third of the diabetics had an objective evidence of neuropathy, mainly a loss of the foot sensation, but only 15% of the IDDM cases and 13% of the NIDDM cases were symptomatic. Peripheral neuropathy can occur before the onset of clinically detectable Diabetes mellitus (DM) [5].Height is an important and a practical predictor of peripheral insensate neuropathy. As the height increases, the lengths of the nerve fibers also increase and so the surface area of the axons is available for the toxin exposure and the physical damage is more. So, the risk of peripheral insensate neuropathy increases with an increase in height. Many studies have shown the corelation of height with p...

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Section: Discussionmentioning

confidence: 71%

“…The proposed hypotheses are, an increase in height associated with an increased nerve length and a greater axon surface area. So, there is a greater risk of injury [1,3,4,14]. The greater the length of the nerve, more prolonged is the time for a complete recovery of the injured nerve{(Cheng YJ et al,) [1] ,(Polydefkis M et al,) [34].…”

Section: Discussionmentioning

confidence: 99%

Peripheral Insensate Neuropathy- Is Height a Risk Factor?

Kote

Bhat²,

Thajuddeen

et al. 2013

JCDR

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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Abstract. Accumulating evidence suggests that smoking is associated with diabetic foot amputation. However, the currently available results are inconsistent and controversial. Therefore, the present study performed a meta-analysis to systematically review the association between smoking and diabetic foot amputation and to investigate the risk factors of diabetic foot amputation. Public databases, including PubMed and Embase, were searched prior to 29th February 2016. The heterogeneity was assessed using the Cochran's Q statistic and the I 2 statistic, and odds ratio (OR) and 95% confidence interval (CI) were calculated and pooled appropriately. Sensitivity analysis was performed to evaluate the stability of the results. In addition, Egger's test was applied to assess any potential publication bias. Based on the research, a total of eight studies, including five cohort studies and three case control studies were included. The data indicated that smoking significantly increased the risk of diabetic foot amputation (OR=1.65; 95% CI, 1.09-2.50; P<0.0001) compared with non-smoking. Sensitivity analysis demonstrated that the pooled analysis did not vary substantially following the exclusion of any one study. Additionally, there was no evidence of publication bias (Egger's test, t=0.1378; P=0.8958). Furthermore, no significant difference was observed between the minor and major amputation groups in patients who smoked (OR=0.79; 95% CI, 0.24-2.58). The results of the present meta-analysis suggested that smoking is a notable risk factor for diabetic foot amputation. Smoking cessation appears to reduce the risk of diabetic foot amputation.

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“…This is despite the fact that preventive foot care practices are often not observed in South Asians as seen in a Canadian study in which 60% of recent immigrants from South Asia and China with diabetes never examined their feet [112]. Shorter height of South Asians may delay the onset of neuropathy which may protect against development of diabetic foot [113].…”

Section: Diabetic Footmentioning

confidence: 97%

Epidemiology of Macrovascular Complications of Diabetes in South Asians and Comparison with Other Ethnicities

Gupta

Misra²

2016

ICFJ

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South Asians have been shown to have increased abdominal adiposity, visceral fat, low muscle mass and subclinical inflammation, all of which make them prone to diabetes and its macrovascular complications. Diabetes is the most important risk factor for coronary artery disease in South Asia and South Asians with diabetes have a higher prevalence of CAD than Caucasians. Similar trend has been seen with stroke and cerebrovascular disease.. Importantly peripheral vascular disease and diabetic foot occur less frequently in South Asians compared to Caucasians. In addition, erectile dysfunction is emerging as an important complication of diabetes in South Asians and its association with cardiovascular disease is being recognised increasingly.

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Prevalence of lower-extremity amputation among patients with diabetes mellitus: Is height a factor?

Cited by 49 publications

References 13 publications

Peripheral Insensate Neuropathy- Is Height a Risk Factor?

Peripheral Insensate Neuropathy- Is Height a Risk Factor?

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

Epidemiology of Macrovascular Complications of Diabetes in South Asians and Comparison with Other Ethnicities

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