Diabetes-related lower-extremity amputation incidence and risk factors: a prospective seven-year study in Costa Rica

Laclé, Adriana; Juan, Luis Félix Valero

doi:10.1590/s1020-49892012000900004

Cited by 62 publications

(73 citation statements)

References 43 publications

(46 reference statements)

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“…Following the reading of the full text of the remaining 47 articles, 39 articles were excluded, including six reviews, 22 articles in which the data could not be extracted and 11 articles with duplicated populations. Finally, eight documents were included in this meta-analysis (23)(24)(25)(26)(27)(28)(29)(30).…”

Section: Resultsmentioning

confidence: 99%

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Smoking increases the risk of diabetic foot amputation: A meta-analysis

et al. 2017

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Abstract. Accumulating evidence suggests that smoking is associated with diabetic foot amputation. However, the currently available results are inconsistent and controversial. Therefore, the present study performed a meta-analysis to systematically review the association between smoking and diabetic foot amputation and to investigate the risk factors of diabetic foot amputation. Public databases, including PubMed and Embase, were searched prior to 29th February 2016. The heterogeneity was assessed using the Cochran's Q statistic and the I 2 statistic, and odds ratio (OR) and 95% confidence interval (CI) were calculated and pooled appropriately. Sensitivity analysis was performed to evaluate the stability of the results. In addition, Egger's test was applied to assess any potential publication bias. Based on the research, a total of eight studies, including five cohort studies and three case control studies were included. The data indicated that smoking significantly increased the risk of diabetic foot amputation (OR=1.65; 95% CI, 1.09-2.50; P<0.0001) compared with non-smoking. Sensitivity analysis demonstrated that the pooled analysis did not vary substantially following the exclusion of any one study. Additionally, there was no evidence of publication bias (Egger's test, t=0.1378; P=0.8958). Furthermore, no significant difference was observed between the minor and major amputation groups in patients who smoked (OR=0.79; 95% CI, 0.24-2.58). The results of the present meta-analysis suggested that smoking is a notable risk factor for diabetic foot amputation. Smoking cessation appears to reduce the risk of diabetic foot amputation.

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Section: Resultsmentioning

confidence: 99%

“…Table I indicates the basic information of the studies involved in the meta-analysis. The enrolled eight studies included five cohort studies (22)(23)(24)26,27) and three case control studies (20,21,25). The publication year ranged from 1992-2015.…”

Section: Resultsmentioning

confidence: 99%

Smoking increases the risk of diabetic foot amputation: A meta-analysis

et al. 2017

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“…20 In a study from Costa Rica showed that diabetic patients who had undergone LEA were men with 10 or more years of diabetes and average HbA1C more than 8%. 21 The number of female patients in our study was 26 (32.91%) out of a total number of 79 patients. Out of total number of 29 amputees, 7 were female patients (24.14%).…”

Section: Resultsmentioning

confidence: 75%

The importance of HbA1C and erythrocyte sedimentation rate as prognostic factors in predicting the outcome of diabetic foot ulcer disease

2017

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Background:The study is to determine the relation between the high HbA1c and ESR as prognostic factors with the severity of the diabetic foot ulcer disease, particularly, in predicting the final outcome in the form of higher incidence of lower extremity amputation (LEA) and/or prolonged hospital stay. The study explored the importance of increased level of serum HbA1c and erythrocyte sedimentation rate (ESR) in determining the final outcome of the disease. It revealed that the severity of diabetic foot ulcer disease is more in patients who had concomitant high levels of baseline HbA1c and ESR on admission. Methods: This observational study was done in 89 patients who were admitted in the surgical wards of the two teaching hospitals in India. The cohort consisted of patients from the age of 26 to 83 years of age who presented with clinically infected foot ulcers. Routine blood tests were done which include HbA1C on the day of admission and fasting ESR (1st hour) on the next day morning. The standard X-ray plates were routinely taken on the first day for determination of the involvement of underlying bones and soft tissues. The outcome of the diabetic foot ulcer was assessed from the severity of the disease according to Meggit-Wagner classification, the incidence of lower extremity amputation and the duration of hospital stay. Results: The high levels of baseline HbA1C (more than 7.0%) in blood on the first day of admission was found in all of the 89 patients who were included in this study but the criteria for consideration of high risk was more than 9% which was found in 41 patients. The criteria for consideration of high ESR in this study was set to be 50 mm/h. High ESR of more than 50 mm was found in 63 patients. We had subdivided 31 patients into a High Risk Group whose baseline levels of HbA1C > 9% and ESR > 50 mm/h. The incidence of amputation was 79.31% and 44.44% with HbA1c of more than 9.0% and ESR of more than 50 mm respectively and was considerably increased (83.87%) when both HbA1c and ESR were more than the critical value as set in the study. Similarly, the incidence of prolonged hospital stay of more than 14 days was 58.54% in patients with HbA1C level of greater than 9 %, 51.85% in patients with baseline ESR > 50 mm/h and 93.55% in presence of high levels of both HbA1C (>9%) and ESR (>50 mm/h).. Conclusions: The study observed that the patients who presented with baseline high levels of HbA1C, ESR or both on admission had unfavourable prognosis with increased incidence of lower extremity amputation and prolonged hospital stay than the other patients in the cohort. .

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“…The diabetic retinopathy accounts for approximately 12% of blindness, and its development is closely related to the time and severity of hyperglycemia, which can develop on average seven years before the diagnosis of DM (1) . A prospective study, which has been conducted in Costa Rica, found that retinopathy was a risk factor for amputation in patients with DM, as well as the longer time of diagnosis, elevated glycated hemoglobin and insulin therapy (20) . Moreover, the visual deficit interferes in the individual's capacity for self-care, especially in this sample in which the majority of participants were elderly.…”

Section: Discussionmentioning

confidence: 99%

Fatores associados à ulceração nos pés de pessoas com diabetes mellitus residentes em área rural

Silva

Haddad

Rossaneis

et al. 2018

Rev. Gaúcha Enferm.

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RESUMO Objetivo Analisar os fatores associados ao risco de ulceração nos pés de pessoas com diabetes mellitus residentes em área rural. Métodos Estudo transversal realizado com 293 pessoas com diabetes mellitus, com 40 anos ou mais, residentes em município do sul do Brasil, em 2014. Analisou-se variáveis socioeconômicas, clínicas e o autocuidado com os pés. Utilizou-se o modelo de regressão múltipla de Poisson e como medida de associação a Razão de Prevalência (RP) e p-valor<0,05. Resultados 43,7% da amostra apresentou risco de ulceração nos pés. A maior prevalência desse risco foi associada a pessoas com menor poder aquisitivo (RPajustada=1,62/IC95%:1,52-2,22), retinopatia (RPajustada=1,30/IC95%:1,12-1,68) e alteração na umidade dos pés (RPajustada=1,57/IC95%:1,22-2,01). Identificou-se baixa escolaridade (64,2%), alta prevalência de hipertensão arterial (86,3%) e onicomicose nos pés (72%). Conclusões Pessoas com diabetes necessitam de avaliação do risco de ulceração nos pés, principalmente, os com maior tempo de diagnóstico, complicações crônicas e baixo nível socioeducacional.

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Diabetes-related lower-extremity amputation incidence and risk factors: a prospective seven-year study in Costa Rica

Cited by 62 publications

References 43 publications

Smoking increases the risk of diabetic foot amputation: A meta-analysis

Smoking increases the risk of diabetic foot amputation: A meta-analysis

The importance of HbA1C and erythrocyte sedimentation rate as prognostic factors in predicting the outcome of diabetic foot ulcer disease

Fatores associados à ulceração nos pés de pessoas com diabetes mellitus residentes em área rural

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