Can Motor Nerve Conduction Velocity Predict Foot Problems in Diabetic Subjects Over a 6-Year Outcome Period?

Carrington, Anne L.; Shaw, Jonathan E.; Schie, Carine H.M. van; Abbott, Caroline A.; Vileikyte, Loretta; Boulton, Andrew J.M.

doi:10.2337/diacare.25.11.2010

Cited by 128 publications

(109 citation statements)

References 24 publications

(41 reference statements)

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“…25 In patients with CLI and falsely high ABI values, the presence of MAC is associated with widespread atherosclerotic changes of the arteries supplying the legs, and, thus, in these patients, both a reduction of vessel lumen and an impairment in the elastic properties of the vessels might contribute to a critical reduction of tissue perfusion, responsible for poor peripheral outcome. 26 A relevant finding of our study is the U-shaped association between the occurrence of major amputation and ABI values, with the lowest rate when the ABI is in the intermediate range. This seems to indicate that a very low ABI, in our series also associated with significantly lower toe pressures, is a reliable marker of severely impaired blood flow to the foot and worse clinical outcome.…”

Section: Discussionmentioning

confidence: 88%

Falsely high ankle-brachial index predicts major amputation in critical limb ischemia

et al. 2006

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Falsely high ankle-brachial index (ABI) values are associated with an adverse clinical outcome in diabetes mellitus. The aim of the present study was to verify whether such an association also exists in patients with chronic critical limb ischemia (CLI) with and without diabetes. A total of 229 patients (74 ± 11 years, 136 males, 244 limbs with CLI) were followed for 262 ± 136 days. Incompressibility of lower limb arteries (ABI > 1.3) was found in 45 patients, and was associated with diabetes mellitus ( p = 0.01) and renal insufficiency ( p = 0.035). Limbs with incompressible ankle arteries had a higher rate of major amputation ( p = 0.002 by log-rank). This association was confirmed by multivariate Cox regression analysis (relative risk [RR] 2.67; 95% CI 1.27-5.64, p = 0.01). The relationship between ABI > 1.3 and amputation rate persisted after subjects with diabetes and renal insufficiency had been removed from the analysis (RR 3.85; 95% CI 1.25-11.79, p = 0.018). Dividing limbs with measurable ankle pressure according to tertiles of ABI, the group in the second tertile (0.323 ≤ ABI ≤ 0.469) had the lowest amputation rate (4/64, 6.2%), and a U-shaped association between the occurrence of major amputation and ABI was evident. No association was found between ABI and mortality. In conclusion, this study demonstrates that falsely high ABI is an independent predictor of major amputation in patients with CLI.

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Section: Discussionmentioning

confidence: 88%

Falsely high ankle-brachial index predicts major amputation in critical limb ischemia

et al. 2006

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“…peroneal nerve conduction velocity) has been shown to be an excellent surrogate endpoint for foot ulceration in trials of agents that might influence the natural history of neuropathy [43].…”

Section: Causal Pathways To Foot Ulcerationmentioning

confidence: 99%

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

2004

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Diabetic foot ulceration represents a major medical, social and economic problem all over the world. While more than 5% of diabetic patients have a history of foot ulceration, the cumulative lifetime incidence may be as high as 15%. Ethnic differences exist in both ulcer and amputation incidences, with both being less common in patients of Indian subcontinent origin living in the UK. Foot ulceration results from the interaction of several contributory factors, the most important of which is neuropathy. With respect to the management of acute Charcot neuroarthropathy in diabetes, recent studies suggest that bisphosphonates reduce disease activity as judged not only by differences in skin temperature, but also by assessing markers of bone turnover. The use of the total-contact cast is demonstrated in the treatment of acute Charcot feet and of plantar neuropathic ulcers. Histological evidence suggests that pressure relief results in chronic foot ulcers changing their morphological appearance by displaying some features of an acute wound. Thus, repetitive stresses on the insensate foot appear to play a major role in maintaining ulcer chronicity. It is hoped that increasing research activity in foot disease will ultimately result in fewer ulcers and less amputation in diabetes.

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“…In order to maximise the available information, we retained three studies [20][21][22] that combined endpoints such as peripheral vascular disease with amputations, assessing the effect of this inclusion through subgroup analysis. We selected 17 studies for inclusion and corresponded with the authors of five [21,[23][24][25][26], of whom two [21,23] provided data, enabling us to calculate relative risks for the 14 studies in this review (Fig. 1).…”

Section: Study Selectionmentioning

confidence: 99%

Association between glycated haemoglobin and the risk of lower extremity amputation in patients with diabetes mellitus—review and meta-analysis

et al. 2010

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Aims/hypothesis Diabetes increases the risk of lower extremity amputation (LEA). Although epidemiological studies report positive associations between glycaemia and LEA, the magnitude of the risk is not adequately quantified and clinical trials to date have not provided conclusive evidence about glucose lowering and LEA risk. We synthesised the available prospective epidemiological data on the association between glycaemia measured by HbA 1c and the risk of LEA in individuals with diabetes. Methods We searched electronic databases and reference lists of relevant articles. We considered prospective epidemiological studies that had measured HbA 1c level and assessed LEA as an outcome among diabetic individuals without acute foot ulcerations or previous history of amputation. Of 2,548 citations identified, we included 14 studies comprising 94,640 participants and 1,227 LEA cases. We abstracted data using standardised forms and obtained data from investigators when required. Data included characteristics of study populations, HbA 1c assay methods, outcome and covariates. Study-specific relative risk estimates were pooled using random-effects model meta-analysis; heterogeneity was explored with metaregression analyses. Results The overall RR for LEA was 1.26 (95% CI 1.16-1.36) for each percentage point increase in HbA 1c . There was considerable heterogeneity across studies (I 2 76%, 67-86%; p<0.001), which was not accounted for by recorded study characteristics. The estimated RR was 1.44 (95% CI 1.25-1.65) for type 2 diabetes and 1.18 (95% CI 1.02-1.38) for type 1 diabetes; however, the difference was not statistically significant (p=0.09). We found no strong evidence for publication bias. Conclusions/interpretation There is a substantial increase in risk of LEA associated with glycaemia in individuals with diabetes. In the absence of conclusive evidence from trials, this paper provides further epidemiological support for glucose-lowering as a strategy to reduce amputation in a population without acute foot ulceration or former amputation; it also provides disease modellers with estimates to assess the overall burden of hyperglycaemia.

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Can Motor Nerve Conduction Velocity Predict Foot Problems in Diabetic Subjects Over a 6-Year Outcome Period?

Cited by 128 publications

References 24 publications

Falsely high ankle-brachial index predicts major amputation in critical limb ischemia

Falsely high ankle-brachial index predicts major amputation in critical limb ischemia

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

Association between glycated haemoglobin and the risk of lower extremity amputation in patients with diabetes mellitus—review and meta-analysis

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