Predictors, consequences and costs of diabetes-related lower extremity amputation complicating type 2 diabetes: The Fremantle Diabetes Study

Davis, Wendy A.; Norman, Paul; Bruce, David; Davis, Timothy

doi:10.1007/s00125-006-0431-0

Cited by 144 publications

(160 citation statements)

References 54 publications

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“…One possible explanation for this is that patients who underwent a lower leg amputation in the present study were only followed until this amputation was performed, whereas in previous Swedish studies, patients were followed and costs calculated until the amputated leg was completely healed [15,17]. Similarly, the cost of a lower leg amputation reported by the recent Australian study is considerably lower than that reported by the present study, mainly because only inpatient costs were included in their analyses [6]. Patients included in the present study who underwent minor amputations below the ankle, which subsequently healed, were classified as healed patients, whereas the costs of minor amputations were presented separately in the previous Swedish studies [15,17].…”

Section: Discussionmentioning

confidence: 58%

“…Studies from Sweden have demonstrated that the cost of treatment for a patient who healed after an amputation were about €29,000-43,000 in the 1990s, depending on the amputation level and whether or not the foot ulcer was infected [3][4][5]. A recent paper on a prospective Australian study reported that, on average, inpatient costs for LEA totalled AU$17,089 [6].…”

Section: Introductionmentioning

confidence: 99%

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Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study

et al. 2008

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Aims/hypothesis The aim of the present study was to investigate resource utilisation and associated costs in patients with diabetic foot ulcers and to analyse differences in resource utilisation between individuals with or without peripheral arterial disease (PAD) and/or infection. Methods Data on resource utilisation were collected prospectively in a European multicentre study. Data on 1,088 patients were available for the analysis of resource use, and data on 821 patients were included in the costing analysis. Costs were calculated for each patient by multiplying the country-specific direct and indirect unit costs by the number of resources used from inclusion into the study up to a defined endpoint. Country-specific costs were converted into purchasing power standards. Results Resource use and costs varied between outcome groups and between disease severity groups. The highest costs per patient were for hospitalisation, antibiotics, Diabetologia (2008) amputations and other surgery. All types of resource utilisation and costs increased with the severity of disease. The total cost per patient was more than four times higher for patients with infection and PAD at inclusion than for patients in the least severe group, who had neither. Conclusions/interpretation Important differences in resource use and costs were found between different patient groups. The costs are highest for individuals with both peripheral arterial disease and infection, and these are mainly related to substantial costs for hospitalisation. In view of the magnitude of the costs associated with inhospital stay, reducing the number and duration of hospital admissions seems an attractive option to decrease costs in diabetic foot disease.

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Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study

et al. 2008

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“…Description of studies Fourteen prospective studies [2,10,12,[20][21][22][23][32][33][34][35][36][37][38] involving 94,640 participants and 1,227 LEA cases were included. Details of study characteristics are provided ( Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Details of study characteristics are provided ( Table 1). The studies were North American and European, with the exception of two, which were conducted in Australia [38] and Jordan [37]. Three studies [10,22,37] had a nested case-control design, the rest had a cohort design.…”

Section: Resultsmentioning

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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“…This disease affects patients by causing pain, decreased quality of life, falls, ulcerations, and amputations 3, 4, 5. Unfortunately, outside of medications for neuropathic pain, few therapies exist to help patients with peripheral neuropathy 4.…”

Section: Introductionmentioning

confidence: 99%

Diabetes and obesity are the main metabolic drivers of peripheral neuropathy

Callaghan

Gao

Li³

et al. 2018

Ann Clin Transl Neurol

150

110

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ObjectiveTo determine the associations between individual metabolic syndrome (MetS) components and peripheral neuropathy in a large population‐based cohort from Pinggu, China.MethodsA cross‐sectional, randomly selected, population‐based survey of participants from Pinggu, China was performed. Metabolic phenotyping and neuropathy outcomes were performed by trained personnel. Glycemic status was defined according to the American Diabetes Association criteria, and the MetS using modified consensus criteria (body mass index instead of waist circumference). The primary peripheral neuropathy outcome was the Michigan Neuropathy Screening Instrument (MNSI) examination. Secondary outcomes were the MNSI questionnaire and monofilament testing. Multivariable models were used to assess for associations between individual MetS components and peripheral neuropathy. Tree‐based methods were used to construct a classifier for peripheral neuropathy using demographics and MetS components.ResultsThe mean (SD) age of the 4002 participants was 51.6 (11.8) and 51.0% were male; 37.2% of the population had normoglycemia, 44.0% prediabetes, and 18.9% diabetes. The prevalence of peripheral neuropathy increased with worsening glycemic status (3.25% in normoglycemia, 6.29% in prediabetes, and 15.12% in diabetes, P < 0.0001). Diabetes (odds ratio [OR] 2.60, 95% CI 1.77–3.80) and weight (OR 1.09, 95% CI 1.02–1.18) were significantly associated with peripheral neuropathy. Age, diabetes, and weight were the primary splitters in the classification tree for peripheral neuropathy.InterpretationSimilar to previous studies, diabetes and obesity are the main metabolic drivers of peripheral neuropathy. The consistency of these results reinforces the urgent need for effective interventions that target these metabolic factors to prevent and/or treat peripheral neuropathy.

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Predictors, consequences and costs of diabetes-related lower extremity amputation complicating type 2 diabetes: The Fremantle Diabetes Study

Abstract: Aims/hypothesis The aims of this study were to assess the incidence, predictors, consequences, and inpatient cost of lower extremity amputation (LEA) in a community-based cohort of type 2 diabetic patients.

Cited by 144 publications

References 54 publications

Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study

Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study

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

Diabetes and obesity are the main metabolic drivers of peripheral neuropathy

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