All-Cause Mortality After Diabetes-Related Amputation in Barbados: A Prospective Case-Control Study

Hambleton, Ian; Jonnalagadda, Ramesh; Fraser, Henry S.; Chaturvedi, Nish; Hennis, Anselm

doi:10.2337/dc09-0885

Cited by 12 publications

(31 citation statements)

References 3 publications

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“…3,13,14 However, the signifi cantly high rate of reamputations and signifi cant mortality of these patients suggest that these patients should be better managed perioperatively. 6,9,10,11,15 Izumi et al found the cumulative rates of upper level reamputation post ray amputation to be as high as 50% after 5 years. 9 Ohsawa et al reported a reamputation rate of 40% after 2 years.…”

Section: Discussionmentioning

confidence: 99%

“…Hambleton et al have reported a similar fi nding in their prospective case controlled study of 205 diabetic foot patients, where sepsis was identifi ed as one of the risk factors for poor outcome. 15 Chronic renal failure and high Cr levels were associated with a poor outcome. This is similar to results published by Sheahan et al, who looked into a mixed cohort of 607 patients with 91.9% of the cohort having diabetes, and reported endstage renal failure and high Cr levels as poor prognostic indicators.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Outcomes of Ray Amputation in Diabetic Foot Patients

Wong

Nather

Chanyarungrojn

et al. 2014

Ann Acad Med Singap

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Dear Editor,Diabetes mellitus is a growing problem in Singapore, with a reported incidence of 11.3% of the Singapore population, a signifi cant increase from 8.2% in 2004. 1 With the implementation of a multidisciplinary approach combined with a clinical pathway, our major amputation rate (below-and above-knee amputation) has been reduced from 31.15% in 2002 to 11.01% in 2007. 2 Nather et al in 2008 identifi ed predictive factors leading to limb loss in diabetic patients to be peripheral vascular disease and infection. 3 Minor amputations in diabetic feet surgery include toe disarticulation, ray amputation, transmetatarsal amputation, Chopart's, Lisfranc's, Syme and Pirogoff amputation. 4 The ray amputation is the commonest minor amputation performed in Singapore, and is preferred to the disarticulation of the toe. 3 Several papers have studied the outcome of minor amputation in diabetic foot patients without further classifying which type of minor amputation was performed. 5,6,7 Others have studied ray amputations in patients with and without diabetes. 8 There are few studies in the literature on the clinical outcome of ray amputation in diabetic foot patients. 9,10,11 These studies reported mainly selective aspects of clinical outcome such as mortality and recurrence of ulcers. 9,10,11 The aim of this paper is to evaluate the factors that would predict a poor outcome following a ray amputation. Materials and MethodsThis is a prospective cohort study of 150 consecutive patients with diabetic foot problems undergoing ray amputation by the National University Hospital (NUH) Diabetes Foot Team from January 2007 to October 2010. Ethics approval from the hospital's ethics board was granted. Informed consent was taken. These patients were followed up for a minimum of 12 months.Demographic data and patient profi le such as age, sex, premorbid status, duration and type of diabetes, comorbidities, presence of risk factors such as smoking, alcoholism, and hyperlipidaemia were recorded. Clinical examination included the vascular status (lower limb pulses, ankle and toe-brachial indexes) and the neuropathy

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Ray Amputation in Diabetic Foot Patients

Wong

Nather

Chanyarungrojn

et al. 2014

Ann Acad Med Singap

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“…Regionally, the Caribbean is known to have a paucity of data regarding foot ulceration and diabetes. This study is one of the first to evaluate risk factors and rates of DFU in such a population, which is known for its high rates of LEAs 6 …”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the morbidity and mortality of patients with ulceration are overwhelming, with LEA rates among the highest in the world at 936 per 100 000 persons 5 . Mortality rates after major amputation were 273.9 per 100 000, and 113.4 after a minor amputation; the highest documented globally 6 . Therefore, DFU represents a major public health concern locally (in Barbados).…”

Section: Introductionmentioning

confidence: 99%

Incidence, prevalence, and potential risk factors for diabetic foot ulceration: A retrospective review at a multidisciplinary centre in Barbados

Lovell

Dunkley

Webb

et al. 2022

International Wound Journal

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Objective: Diabetes and lower extremity amputation rates in Barbados are among some of the highest globally, with peripheral neuropathy and peripheral vascular disease found to be independent risk factors for this population. Despite this, there is currently a lack of research evidence on rates of diabetic foot ulceration, which has amputation as its sequela. We aimed to evaluate the incidence and prevalence rates of active ulceration in a population of people with diabetes in Barbados. Secondly, we explored the risk factors for new/recurrent ulceration.Research Design and Methods: Data were extracted from the electronic medical records for the period January 1, 2019 to December 31, 2020 for a retrospective cross-sectional study for patients of a publicly-funded diabetes management programme. Eligible records included people aged 18 years and above with a diagnosis of type 1 or 2 diabetes. Potential risk factors were explored using univariable logistic regression models. Results: A total of 225 patients were included in the study (96% type 2 diabetes, 70.7% female, 98.7% Black Caribbean). The 1-year period prevalence of diabetic foot ulceration was 14.7% (confidence interval [

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“…The evidence is clear that morbidity and mortality are disproportionately high in this cohort which may provide the impetus for podiatrists to treat with diligence and care. 49–51…”

Section: Methodsmentioning

confidence: 99%

What is the Lived Experience of the ‘Three Great Pathologies’ of Diabetic Foot Disease? An Interpretative Phenomenological Analysis of the Independent Thinking of Podiatrists in Diabetes Secondary Care

Speight

Morriss-Roberts

2022

INQUIRY

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Researching the podiatrists’ lived experience of The Three Great Pathologies may help improve the quality of patient care. The aim of this research using an Interpretative Phenomenological Analysis approach is to report on insights relating to the Three Great Pathologies of diabetic foot disease – infection, ischaemia and amputation. To do this, data was collected from six New Zealand diabetes care Podiatrists. Three superordinate themes resulted with subordinate themes. They are compromised health status, podiatric challenges and best outcomes. The findings are firstly, patient education remains a priority; secondly, there is an unmet need for postgraduate podiatry education; and thirdly, early intervention is a key measure for reducing the influence of the Three Great Pathologies. This study demonstrates that focussing on a group of six specialist podiatrists contributes to new priorities of care for dealing with the Three Great Pathologies of diabetic foot disease.

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All-Cause Mortality After Diabetes-Related Amputation in Barbados: A Prospective Case-Control Study

Cited by 12 publications

References 3 publications

Clinical Outcomes of Ray Amputation in Diabetic Foot Patients

Clinical Outcomes of Ray Amputation in Diabetic Foot Patients

Incidence, prevalence, and potential risk factors for diabetic foot ulceration: A retrospective review at a multidisciplinary centre in Barbados

What is the Lived Experience of the ‘Three Great Pathologies’ of Diabetic Foot Disease? An Interpretative Phenomenological Analysis of the Independent Thinking of Podiatrists in Diabetes Secondary Care

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