A comparison of diabetic smokers and non-smokers who undergo lower extremity amputation: a retrospective review of 112 patients

Anderson, John J.; Boone, Joshua J.; Hansen, Myron; Spencer, Loren; Fowler, Zflan

doi:10.3402/dfa.v3i0.19178

Cited by 15 publications

(3 citation statements)

References 11 publications

(11 reference statements)

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“…Smoking persons with diabetes have more proximal amputations. 30 Part of the explanation to differences in outcomes is likely to be worse hyperglycaemia and higher prevalence of smoking in the lower SEP groups.…”

Section: Strengths and Weaknesses In Relation To Other Studies Discumentioning

confidence: 99%

Amputations and socioeconomic position among persons with diabetes mellitus, a population-based register study

et al. 2013

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ObjectiveLow socioeconomic position is a known health risk. Our study aims to evaluate the association between socioeconomic position (SEP) and lower limb amputations among persons with diabetes mellitus.DesignPopulation-based register study.SettingFinland, nationwide individual-level data.ParticipantsAll persons in Finland with any record of diabetes in the national health and population registers from 1991 to 2007 (FinDM II database).MethodsThree outcome indicators were measured: the incidence of first major amputation, the ratio of first minor/major amputations and the 2-year survival with preserved leg after the first minor amputation. SEP was measured using income fifths. The data were analysed using Poisson and Cox regression as well as age-standardised ratios.ResultsThe risk ratio of the first major amputation in the lowest SEP group was 2.16 (95% CI 1.95 to 2.38) times higher than the risk in the highest SEP group (p<0.001). The incidence of first major amputation decreased by more than 50% in all SEP groups from 1993 to 2007, but there was a stronger relative decrease in the highest compared with the lowest SEP group (p=0.0053). Likewise, a clear gradient was detected in the ratio of first minor/major amputations: the higher the SEP group, the higher the ratio. After the first minor amputation, the 2-year and 10-year amputation-free survival rates were 55.8% and 9.3% in the lowest and 78.9% and 32.3% in the highest SEP group, respectively.ConclusionsAccording to all indicators used, lower SEP was associated with worse outcomes in the population with diabetes. Greater attention should be paid to prevention of diabetes complications, adherence to treatment guidelines and access to the established pathways for early expert assessment when diabetic complications arise, with a special attention to patients from lower SEP groups.

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Section: Strengths and Weaknesses In Relation To Other Studies Discumentioning

confidence: 99%

Amputations and socioeconomic position among persons with diabetes mellitus, a population-based register study

et al. 2013

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“…There have been several studies that revealed the relationship between smoking tobacco status and lower limb amputations (Anderson et al 2012;Lin et al 2020). In our study, smoking tobacco was statistically significant as a risk factor for major amputation in the univariate analysis and >30 pack/year remained statistically significant in the multivariate analysis (p=0.011, HR=1.931).…”

Section: Discussionmentioning

confidence: 99%

An index to prevent major limb amputations in diabetic foot

Zengin,

Yuzuguldu,

Simsir

et al. 2023

Endocrine Regulations

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Objective. Besides the early detection and treatment of diabetic foot ulcers, being aware of the risk factors for major amputation plays a crucial role in preventing the major lower limb amputations. Major lower limb amputations are not just mentally and physically hard for patients, but also have an effect on patient’s survival and are a financial burden on both patients and healthcare systems. Subjects and Methods. We defined 37 potential risk factors for major amputation and these risk factors were investigated among 507 patients who had ulcers in their feet and were seen by the diabetic foot ulcer council at Ege University Faculty of Medicine. In our study, 106 (20.9%) patients ended up undergoing major lower limb amputation. Results. The univariate analysis showed that 24 defined risk factors were statistically significant. In the multivariate analysis using the Cox regression model, 6 risk factors remained statistically significant. Multivariate-adjusted hazard ratios were 4.172 for hyperlipidemia, 3.747 for albumin <3.365 g/dL, 3.368 for C-reactive protein (CRP) >2.185 mg/L, 2.067 for presence of gangrenous Wagner stage, 1.931 for smoking tobacco >30 pack/year, and 1.790 for hematocrit (HCT) <31.5%. Most patients with major amputation presented with a neuroischemic foot (58%). Gender and age were not found to be risk factors for major amputation. Having less than 7% of hemoglobin A1c (HbA1c) levels had a direct proportion with major amputation numbers. The mortality rates in one year, two and three years after the major amputation operations were 24.6%, 30%, and 35.9%, respectively. Conclusion. Being familiar with these risk factors for major amputation is crucial for multi-disciplinary teams to take good care of patients with diabetic foot ulcers and to lower the need for major amputations.

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“…Smoking cigarettes has been shown to delay wound healing [28,29] and diabetic patients with foot ulcers who smoke are more likely to require amputation than non-smokers [30]. In RA patients smoking cigarettes has been linked with increased disease activity [31][32][33] and the development of rheumatoid nodules [34].…”

Section: Methodsmentioning

confidence: 99%

Prevalence and microbiological characteristics of clinically infected foot‐ulcers in patients with rheumatoid arthritis: a retrospective exploratory study

Fitzgerald

Siddle

Backhouse

et al. 2015

Journal of Foot and Ankle Research

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BackgroundThe prevalence of foot ulcers in patients with rheumatoid arthritis (RA) has been reported at almost 10 %. These foot ulcers often occur at multiple sites and are reoccurring, with the potential risk of infection increased due to RA diagnosis and disease modifying medications. The objective of this study was to estimate the prevalence of clinical infection in foot-ulcers of patients with RA; describe the microbiological characteristics and investigate risk factors.MethodsRetrospective clinical data was collected for all patients attending a rheumatology foot ulcer clinic between 1st May 2012 and 1st May 2013: wound swab data was collected from those with clinical infection.ResultsTwenty-eight patients with RA and foot-ulcers were identified; eight of these patients had clinical infection and wound swabs taken (29 %).Of these eight patients there were equal men and women, with median age 74 years, and average disease duration 22 years.Cardiovascular disease/peripheral-vascular disease (CVD/PVD) were reported in six patients, diabetes in two patients.Six patients were treated with disease-modifying anti-rheumatic drugs (DMARDs); three were on biologic medications and two on steroids.Five wound swabs cultured skin flora, one staphylococcus aureus, one had no growth after culture; and one was rejected due to labelling error.ConclusionAlmost a third of people with RA and foot ulcers attending clinic over one year had clinical infection, however microbiological analysis failed to isolate pathogens in six of seven wound swabs. This may be due to inaccurate diagnosis of ulcer infection or to issues with sampling, collection, transport, analysis or reporting. There was insufficient data to relate risk of clinical infection with risk factors.Further research is required to identify the most appropriate techniques for infection diagnosis, wound sampling and processing.Trial registrationEthical approval was obtained from University of Leeds, Faculty of Medicine and Health (Reference number: SHREC/RP/349).

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A comparison of diabetic smokers and non-smokers who undergo lower extremity amputation: a retrospective review of 112 patients

Cited by 15 publications

References 11 publications

Amputations and socioeconomic position among persons with diabetes mellitus, a population-based register study

Amputations and socioeconomic position among persons with diabetes mellitus, a population-based register study

An index to prevent major limb amputations in diabetic foot

Prevalence and microbiological characteristics of clinically infected foot‐ulcers in patients with rheumatoid arthritis: a retrospective exploratory study

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