Diabetes as an isolated cause of minor lower limb amputations

Abstract

Objectives: Amputation is a devastating but preventable complication of diabetes and peripheral arterial disease. The aim of the present study was to investigate whether diabetes mellitus is an important isolated cause of toe amputation. Methods: A cross-sectional study was conducted involving the records of 108 patients with minor lower limb amputations and 80 with major lower limb amputations. Association between diabetes/chronic arterial insufficiency and level of amputation was tested. Statistical analysis was performed using Fisher’s exact test. Results: The prevalence of diabetes was 87.5% among patients submitted to minor amputations and 52.5% among those submitted to major amputations with or without chronic arterial disease. This difference was statistically significant (p<0.0001, Fisher’s exact test). A total of 44.44% of the patients submitted to minor amputations had diabetes alone (no chronic arterial insufficiency), whereas only 14.81% of the patients submitted to major amputations did not have chronic arterial insufficiency. Thus, diabetes was significantly associated with minor lower limb amputations (p<0.0004, Fisher’s exact test). Conclusion: Based on the present findings, patients with diabetes are at greater risk of toe amputation compared to those with chronic arterial disease.

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“…This ultimately culminates in an inability of the β-cells to produce sufficient insulin to overcome the lowered sensitivity, thus resulting in fasting hyperglycemia, which is clinically categorized as T2D [ 4 ]. The dysregulation of blood glucose levels is detrimental to a person’s overall health, as a chronically elevated blood glucose can lead to an array of secondary complications, including a state of chronic low-grade inflammation [ 5 ], chronic kidney disease [ 6 ], cardiovascular disease [ 7 ], retinopathy [ 8 ], and neuropathy [ 9 ], which often lead to a plethora of podiatric issues that can ultimately necessitate limb amputation [ 10 ]. The current treatments for T2D include diet modification, exercise, and pharmaceutical agents that work via several mechanisms, including promoting insulin sensitivity and production, promoting GLP-1 activity and longevity, and inhibiting hepatic gluconeogenesis and glucose reabsorption in the kidneys [ 11 , 12 ].…”