Factors associated with diabetic foot amputations

Abstract

Background: Diabetes and the problem of the diabetic foot specifically are a severe burden on the public healthcare system. Amputations caused by this condition are still common in our setting (Brazil), although the true magnitude of the problem is not known with certainty. Lower limb amputation rates have come to be seen as an indicator of the quality of preventative care of the diabetic foot. Objective: To identify associations between amputations and factors related to people, to morbidities and to primary care received. Methods: This was a cross-sectional study of a sample of 137 patients with diabetic feet admitted to a large hospital in the city of Recife, Pernambuco, Brazil. Logistic regression analysis was conducted. Results: Associations with amputation were detected for the following variables: age over 60; resident of the Metro zone; income of three minimum salaries or less; presence of gangrene on admission; glycemia ≥ 126 mg/dL; smoking; not receiving information about results of glycemia testing; not having feet examined, and not being given guidance on caring for feet at consultations during the previous year. Conclusions: Factors related to Primary Care, such as time since onset of ulcers, information about results of glycemia testing and lack of guidance on how to care for their feet, were associated with occurrence of lower limb amputations. ResumoContexto: O diabetes e especificamente o problema do pé diabético representam grave adversidade ao sistema de saúde pública. As amputações resultantes deste agravo ainda são frequentes em nosso meio, embora não se conheça ao certo a sua magnitude. A taxa de amputações de membros inferiores tem sido considerada um indicador da qualidade dos cuidados preventivos do pé diabético. Objetivo: Identificar a existência de associação entre amputações e fatores relacionados às pessoas, à morbidade e à atenção básica recebida. Métodos: Estudo transversal que incluiu uma amostra de 137 portadores de pé diabético internados em hospital de grande porte da cidade do Recife. Realizou-se análise de regressão logística. Resultados: Verificou-se associação para as variáveis: idade de 60 anos ou mais; procedência da Região metropolitana; renda de até três salários mínimos; presença de gangrena à admissão; glicemia de 126 mg/ dL ou mais; tabagismo; não receber informação dos resultados da glicemia; não ter os pés examinados, e não receber orientação sobre cuidados com os pés nas consultas do ano anterior. Conclusões: Fatores relacionados à Atenção Básica, tais como o tempo de ocorrência da úlcera, a informação dos resultados do exame de glicemia e a falta de orientação sobre cuidados com os pés, estiveram associados com a ocorrência de amputações de membros inferiores.Palavras-chave: pé diabético; amputação; atenção básica.

Quality of Life and Associated Factors in Indonesian Diabetic Patients with Foot Ulcers

“…The decrease of QOL due to high blood glucose in patients with diabetic foot ulcer might because high blood glucose will cause the wound to deteriorate into more severe foot ulcer. A previous study by Santos, Carvalho, Souza, & Albuquerque (2015) showed that high blood glucose would cause deterioration of wound to a more severe ulcer, and finally lead to foot amputation.…”

Impacto de intervenções educativas na redução das complicações diabéticas: revisão sistemática

“…Investigations indicate that inadequate management of blood glucose level is a factor associated with the presence of feet ulcers (28) and with amputation among individuals with diabetic foot (29) . However, it is important to analyze the influence of educational interventions on outcomes associated with complications of DM, in addition to the specific serum levels of glucose or glycated hemoglobin.…”

“…Sensory loss secondary to peripheral diabetic neuropathy, at times, goes unnoticed by the patient and the first presentation can be feet ulcer (32) . In Brazil, the rate of amputations among individuals with diabetic foot reaches 58.2% (29,37) . In addition to inadequate control of blood glucose, other factors associated with amputation include: lack of feet examination during the most recent medical consultation, lack of instructions on the care of feet in the consultations held the previous year, and non-adherence to pharmacological treatment according to medical advice (29) .…”

“…In Brazil, the rate of amputations among individuals with diabetic foot reaches 58.2% (29,37) . In addition to inadequate control of blood glucose, other factors associated with amputation include: lack of feet examination during the most recent medical consultation, lack of instructions on the care of feet in the consultations held the previous year, and non-adherence to pharmacological treatment according to medical advice (29) . In fact, in the United States, there is a regional variation of rates of amputations of the lower limbs: in areas where there is participation of individuals with DM in classes on self-control of the disease there is fewer occurrences of amputations when compared to regions where this participation does not occur (38) .…”

Evolution of a diabetic foot wound with the use of calendula: A single‐case experimental design

“…The prevalence of foot ulcers reaches 4-10% of those with the disease. The absence of treatment or inadequacy of the same causes serious consequences, including amputation and death (Powers, Higham, Broussard, & Phillips, 2016;Santos, Sobreira, Nunes, & Morais, 2013;Wang et al, 2016). In young patients, the treatment method consists of aggressive revascularization and infection control to avoid amputations.…”