Risk factors for lower extremity amputation in patients with diabetic foot ulcers: A meta-analysis

Abstract

A considerable number of diabetic foot ulcer (DFU) patients require amputation every year, which worsens their quality of life, aggravates the social burden, and shortens their life expectancy. Considering these negative effects, it is important to explore the relative risk factors affecting amputation in DFU patients.

Rates and risk factors for amputation in people with diabetes in Japan: a historical cohort study using a nationwide claims database

“…In our multivariate analysis, HbA1c was independently associated with amputation. Interestingly, a recent meta-analysis showed that the HbA1c level does not affect the incidence of amputation in patients with diabetic foot ulcers [ 13 ]. Intensive control may decrease the risk of amputation in patients with diabetic foot syndrome [ 24 ].…”

“…Age plays an important role in atherosclerosis, resulting in an increased risk of cardiovascular disease. No clear association was observed between age and amputation in patients with diabetic foot ulcers [ 13 ]. We found that age was independently associated with lower limb amputation, which was consistent with a previous study [ 25 ].…”

“…Longer exposure to glycated haemoglobin A1c (HbA1c) levels above target was associated with increased risk of both micro- and macrovascular complications [ 11 , 12 ]. However, a recent meta-analysis evaluating risk factors for lower extremity amputation in patients with diabetic foot ulcers showed that HbA1c levels do not affect the incidence of amputation [ 13 ]. Studies included in that meta-analysis were only on patients with diabetic foot ulcers who had received recent intensive treatment [ 13 ], suggesting that the impact of HbA1c on amputation may have been underestimated.…”

“…Age is an established independent risk factor for atherosclerosis and macrovascular complications in people with diabetes [ 14 , 15 ]. However, a meta-analysis showed that age was not related to amputation in diabetic foot ulcer patients [ 13 ]. In most studies, the average participants are middle aged or older [ 10 , 16 , 17 ].…”

Prevalence and Medical Resource of Patients with Diabetic Foot Ulcer: A Nationwide Population-Based Retrospective Cohort Study for 2001–2015 in Taiwan

“…The amputation rate in diabetics is 10–30 times more than that in non-diabetics and account for 69–80% of non-traumatic amputations [ 6 , 7 ]. The risk factors of DFU include age, male, peripheral neuropathy, peripheral vasculopathy, smoking, trauma, history of diabetes for >10 years, and glycated hemoglobin of >7.5%, all of which positively correlate with DFU [ 8 ]. The medical expenditure for DFU is extremely high as it increases the length of hospitalization and the number of emergency and outpatient visits.…”