Assessing the risk of lower extremity amputations using an administrative data-based foot risk index in elderly patients with diabetes*

Helmer, Drew A.; Tseng, Chin‐Lin; Wrobel, James S.; Tiwari, Anjali; Rajan, Mangala; Pogach, Leonard; Sambamoorthi, Usha; Feinglass, Joseph

doi:10.1111/j.1753-0407.2011.00135.x

Cited by 12 publications

(9 citation statements)

References 14 publications

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“…To try to narrow the scope to persons with prevalent DFUs, we also required that the participant have at least one CPT code for debridement (11040, 11041, 11042, 11043, or 11044). Amputation was defined as the presence of at least one ICD9 procedure code for amputation (84.11, 84.12, 84.13-84.16, or 84.17-84.19), ICD9 status code for amputation (v49.7), or CPT code for amputation (27590-8, 27880-9, 28800, 28805, 28810, 28820, or 28825) in any inpatient or outpatient records (10). …”

Section: Methodsmentioning

confidence: 99%

“…In the United States, as many as 15% of people with diabetes will have lower extremity amputations during their lifetime (9), and substantially higher rates are associated high-risk foot conditions like Charcot neuroosteoarthropathy and DFU (10). While the causal pathways leading to Charcot and DFU, or eventually, lower-extremity amputation, may differ, they are all identified by comprehensive foot examination including inspection of the dermatologic and musculosketal systems, sensory examination, and pulse evaluation, and with appropriate treatment, often are preventable (11).…”

Section: Introductionmentioning

confidence: 99%

“…Managed care organizations, which provide access to care and prevention, should be well positioned to screen and prevent foot complications. Studies have not yet reported on the prevalence and risk factors of diabetic foot complications in managed care organizations other than in the VA (6,10,13-15). Our objective was to describe the prevalence of diabetes-related foot complications in a managed care population and to identify the demographic and biological risk factors associated with each of the three major diabetes-related foot complications.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and risk factors for diabetes-related foot complications in Translating Research Into Action for Diabetes (TRIAD)

McEwen

Ylitalo

Herman

et al. 2013

Journal of Diabetes and its Complications

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Aims The objective was to describe the prevalence of diabetes-related foot complications in a managed care population and to identify the demographic and biological risk factors. Methods We assessed the period prevalence of foot complications on 6,992 patients using ICD-9 diagnosis codes from health plan administrative data. Demographic and biological variables were ascertained from surveys and medical record reviews. We defined four mutually exclusive groups: any Charcot foot, DFU with debridement, amputation ± DFU and debridement, and no foot conditions. Results Overall, 55 (0.8%) patients had Charcot foot, 205 (2.9%) had DFU with debridement, and 101 (1.4%) had a lower-extremity amputation. There were 6,631 patients with no prevalent foot conditions. Racial/ethnic minorities were less likely to have Charcot foot (OR=0.21; 95%CI: 0.10, 0.46) or DFU (OR=0.61; 95% CI: 0.44, 0.84) compared to non-Hispanic Whites, but there were no racial/ethnic differences in amputation. Histories of micro- or macrovascular disease were associated with a two- to four-fold increase in the odds of foot complications. Conclusion In managed care patients with uniform access to health care, we found a relatively high prevalence of foot complications, but attenuation of the racial/ethnic differences of rates reported in the literature.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence and risk factors for diabetes-related foot complications in Translating Research Into Action for Diabetes (TRIAD)

McEwen

Ylitalo

Herman

et al. 2013

Journal of Diabetes and its Complications

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“…We hypothesized that the subgroup of patients with severe diabetic foot ulcers, namely those complicated by osteomyelitis or gangrene, would have the highest associated mortality among patients with diabetic foot ulcers. This was based upon the finding that severe ulcers are associated with increased morbidity, especially major (above ankle) amputation (Prompers et al, 2008 a ; Helmer et al, 2011; Peters et al, 2001). Therefore, our aim was to determine whether the severity of incident diabetic foot ulcers at presentation predicts subsequent mortality.…”

Section: Introductionmentioning

confidence: 99%

Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes

Brennan

Hess

Bartle³

et al. 2017

Journal of Diabetes and its Complications

125

102

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Aim Diabetic foot ulcers are associated with an increased risk of death. We evaluated whether ulcer severity at presentation predicts mortality. Methods Patients from a national, retrospective, cohort of veterans with type 2 diabetes who developed incident diabetic foot ulcers between January 1, 2006 and September 1, 2010, were followed until death or the end of the study period, January 1, 2012. Ulcers were characterized as early stage, osteomyelitis, or gangrene at presentation. Cox proportional hazard regression identified independent predictors of death, controlling for comorbidities, laboratory parameters, and healthcare utilization. Results 66,323 veterans were included in the cohort and followed for a mean of 27.7 months: 1-, 2-, and 5-year survival rates were 80.80%, 69.01% and 28.64%, respectively. Compared to early stage ulcers, gangrene was associated with an increased risk of mortality (HR 1.70, 95% CI 1.57 – 1.83, p<0.001). The magnitude of this effect was greater than diagnosed vascular disease, i.e., coronary artery disease, peripheral arterial disease, or stroke. Conclusion Initial diabetic foot ulcer severity is a more significant predictor of subsequent mortality than coronary artery disease, peripheral arterial disease, or stroke. Unrecognized or under-estimated vascular disease and/or sepsis secondary to gangrene should be explored as possible causal explanations.

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“…This paper examines the specific case of diabetes. The prevalence of type 2 diabetes mellitus (DM) is rising and today represents a serious public health problem [6]. Patients with diabetes are characterized by peculiarities that have implications for both diagnosis and management.…”

Section: Introductionmentioning

confidence: 99%

Caregiver Burden in the Management of Frail Elderly Patients with Diabetes in Internal Medicine

Ripoll¹,

Llinares²,

Pérez³

et al. 2018

Health

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Aim: Advanced age and fragility often lead to dependence, making caregiver assistance necessary for performing the activities of daily living. Patients with diabetes are characterized by an elevated presence of comorbidities and subsequent frailty-a relevant consideration when making decisions regarding treatment goals. Health professionals may overlook the caregiver experience when assessing the circumstances surrounding frail elderly patients with diabetes, but this factor can have a large impact on relevant caregiver and patient outcomes. Methods: An observational, retrospective study was carried out to assess the impact of improved management in diabetes on caregiver burden. We assessed patients' performance of activities of daily living using the Barthel scale. Our primary outcome was caregiver burden, as assessed using the Zarit scale. Results: At baseline, 81.4% of the caregivers reported severe overburden (>55 points on the Zarit scale). At three months, the proportion of caregivers reporting this level of burden had dropped to 76.7% and remained stable at six months (77.1%). In contrast, 8.5% of the caregivers reported moderate overburden (47 to 55 points) at baseline, compared to 13.3% at three months and 12.5% at six. The proportion of caregivers reporting no overburden (<47 points) was similar at all time points (10.2%, 10.0% and 10.4% at baseline, three months and six months, respectively

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Assessing the risk of lower extremity amputations using an administrative data-based foot risk index in elderly patients with diabetes*

Abstract: An administrative data-derived foot risk category was associated with risk of ILEA in a risk level-dependent pattern.

Cited by 12 publications

References 14 publications

Prevalence and risk factors for diabetes-related foot complications in Translating Research Into Action for Diabetes (TRIAD)

Prevalence and risk factors for diabetes-related foot complications in Translating Research Into Action for Diabetes (TRIAD)

Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes

Caregiver Burden in the Management of Frail Elderly Patients with Diabetes in Internal Medicine

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