Prevalence and factors associated with lower limb amputation in individuals with type II diabetes mellitus in a referral hospital in Fortaleza, Ceará, Brazil: A hospital-based cross-sectional study

Abstract

Aims To analyze the association between demographic, socioeconomic, clinical, epidemiological, and primary healthcare factors with the severity of lower limb amputations (LLAs) in individuals with type II diabetes mellitus (DM-II) at a reference hospital in Fortaleza, Ceará, in Northeast Brazil. Methods A cross-sectional study was performed with a representative sample of individuals hospitalized with DM-II and the degree of LLA severity: (1) toes; (2) transmetatarsal or infrapatellar; (3) suprapatellar; (4) disarticulation or bilateral. Potentially associated factors with the outcome degree of amputation severity were identified in a semi-structured evaluation during hospitalization. The prevalence ratios of the degree of amputation severity as a function of associated factors were calculated with robust variance Poisson regression models. Results The prevalence of high degree of severity in amputations (suprapatellar, with disarticulation or bilateral) was high in the total sample of 385 patients, revealing to be 49% (187/385). Prevalence ratios (PR) indicated a higher prevalence of DM-II amputation severity in patients who lacked of specific guidance on DM-II amputation in primary care (PR = 1.52, 95% CI: 1.05–2.21). Conclusions LLAs in DM-II were associated with age above 67 years, male gender, cardiovascular disease, and low support for guidance at the primary healthcare level.