Does Amputation Negatively Influence the Incidence of Depression in Diabetic Foot Patients? A Population-Based Nationwide Study

Abstract

This study aimed to investigate the relationship between diabetic foot ulcer and depression based on treatment methods employed, as evaluated according to Medicare claims data provided by the Health Insurance Review and Assessment Service (HIRA). Data on diabetic foot patients from January 2011 to December 2016 were collected from the HIRA using codes for diabetic foot and depression disorder. The incidence of depression was analyzed based on patients’ demographic variables, and comorbidities were assessed using the Charlson comorbidity index (CCI). The participants were divided into two groups based on the treatment method used: a limb-saving group and an amputation group. The 1-, 3-, and 5-year incidence rates of depression were 10.1%, 20.4%, and 29.5%, respectively, in the limb-saving group and 4.5%, 8.2%, and 11.5%, respectively, in the amputation group. Female sex, the CCI, and the use of limb-saving treatment methods were significant risk factors. It is plausible that depression in diabetic foot patients may be associated with frequent recurrence and chronicity rather than a single intense event. Our findings highlight the need for clinicians to consider the treatment period as a contributor to patient mood disorders when selecting the appropriate course of action in patients.

Management of diabetic foot ulcers: a narrative review

“…Despite desperate efforts to rescue the foot, amputation is unavoidable in some cases. Although various types of amputation are possible depending on the extent of DFUs, a careful approach should be taken because limb amputation may increase the patient's physical, economic, and emotional burden [ 21 , 22 ]. The foremost principle to consider when determining the level of amputation is that energy consumption after amputation is inversely proportional to the length of the residual limb [ 23 ].…”