Reduced Incidence of Lower-Extremity Amputations in People With Diabetes in Scotland

Kennon, Brian; Leese, Graham; Cochrane, Lindy; Colhoun, Helen M.; Wild, Sarah H.; Stang, Duncan; Sattar, Naveed; Pearson, Donald; Lindsay, Robert; Morris, Andrew D.; Livingstone, Shona; Young, Matthew J.; McKnight, John; Cunningham, Scott

doi:10.2337/dc12-0511

Cited by 95 publications

(107 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our data were obtained in [2003][2004], and the incidence of lower-extremity amputation in patients with diabetic foot ulcers has decreased since then in several countries (28). However, studies have observed that the relative risk of amputation for these patients has not changed (29,30), which is why we believe our results are still valid and applicable.…”

Section: Limitations Of the Current Studymentioning

confidence: 60%

Predictors of Lower-Extremity Amputation in Patients With an Infected Diabetic Foot Ulcer

et al. 2015

View full text Add to dashboard Cite

OBJECTIVEInfection commonly complicates diabetic foot ulcers and is associated with a poor outcome. In a cohort of individuals with an infected diabetic foot ulcer, we aimed to determine independent predictors of lower-extremity amputation and the predictive value for amputation of the International Working Group on the Diabetic Foot (IWGDF) classification system and to develop a risk score for predicting amputation. RESEARCH DESIGN AND METHODSWe prospectively studied 575 patients with an infected diabetic foot ulcer presenting to 1 of 14 diabetic foot clinics in 10 European countries. RESULTSAmong these patients, 159 (28%) underwent an amputation. Independent risk factors for amputation were as follows: periwound edema, foul smell, (non)purulent exudate, deep ulcer, positive probe-to-bone test, pretibial edema, fever, and elevated C-reactive protein. Increasing IWGDF severity of infection also independently predicted amputation. We developed a risk score for any amputation and for amputations excluding the lesser toes (including the variables sex, pain on palpation, periwound edema, ulcer size, ulcer depth, and peripheral arterial disease) that predicted amputation better than the IWGDF system (area under the ROC curves 0.80, 0.78, and 0.67, respectively). CONCLUSIONSFor individuals with an infected diabetic foot ulcer, we identified independent predictors of amputation, validated the prognostic value of the IWGDF classification system, and developed a new risk score for amputation that can be readily used in daily clinical practice. Our risk score may have better prognostic accuracy than the IWGDF system, the only currently available system, but our findings need to be validated in other cohorts.Infection is a frequent complication of diabetic foot ulcers, with up to 58% of ulcers being infected at initial presentation at a diabetic foot clinic, increasing to 82% in patients hospitalized for a diabetic foot ulcer (1). These diabetic foot infections (DFIs) are associated with poor clinical outcomes for the patient and high costs for both the patient and the health care system (2). Patients with a DFI have a 50-fold increased risk of hospitalization and 150-fold increased risk of lowerextremity amputation compared with patients with diabetes and no foot infection (3). Among patients with a DFI, ;5% will undergo a major amputation and 20-30% a

show abstract

Section: Limitations Of the Current Studymentioning

confidence: 60%

Predictors of Lower-Extremity Amputation in Patients With an Infected Diabetic Foot Ulcer

et al. 2015

View full text Add to dashboard Cite

show abstract

“…DFI is the leading cause of non-traumatic lower limb amputations. [4][5][6][7] The main aim was to study the DFI which is responsible for increased morbidity, amputations and even mortality in diabetic patients. [8][9][10] Diabetic foot infections were more common (33.33%) in age group of 45-54 years whereas P.C Leung reported 75% infections occurred above the age of 50 years.…”

Section: Discussionmentioning

confidence: 99%

Diabetic foot infections and management: A Rural Indian Perspective

Mote¹,

Mote²

2015

Int Jour of Biomed Res

View full text Add to dashboard Cite

Aim and objective: This study was carried out to study demographic features of patients suffering from diabetic foot infections and also to know microorganism causing infections and its management. Study design: It is a hospital based cohort study. Place and duration of study: Department of General Surgery, K.I.M.S, Andhra Pradesh, from Jan 2007 to December 2009. Material and methods: The study was conducted at tertiary care teaching hospital in Andhra Pradesh from 2007 to 2009. The patients of both gender and all age groups who presented with diabetic foot infections comprised the study. The history of diabetic foot was obtained and thorough clinical examination was carried out after written informed consent from patient. The Subject underwent routine and specialized investigations like swab for culture and sensitivity, radiographs of foot. The patients were managed with insulin or oral anti diabetic agents, debridement, drainage, skin grafting. The severe infection cases required amputations to save life of patients. All patients followed until discharge or death. Results: Out of 60 cases 40 were male and 20 female patients. Diabetic foot ulcers were more common in age group of 45-54 (33.33%).Diabetic foot infections were observed more in patients having diabetes for duration of more than years (75.00%). More than 60 % of cases were in Wagner's grade III to V. Most common organisms responsible for diabetic foot infection were gram positive organisms, 43.33% of cases whereas 16.67% had poly microbial infection.The present study revealed that ceftriaxone was found to be effective in 33.33% of cases of infections followed by amikacin in 25% of cases . Amputations were done in 43.33% cases due to severe life threating spreading, uncontrolled infections. Conclusion: As the diabetic mellitus cases are increasing globally, it is becoming the public health problem. There is huge burden on economy, health system and on society. It is affecting the quality of life of citizens which requires orchestrated efforts from all stake holders to prevent and minimise the foot infections and reduce the number of amputations.

show abstract

“…A statistically significant reduction of 40% in LEA rates occurred between 2004 and 2008. 11 However, the 2013 Scottish Diabetes Survey shows that the absolute numbers and percentages of diabetes-related foot ulcerations and LEA have increased, although this is attributed to better recording procedures. In England, an analysis of national hospital activity data from 1996 to 2005 found that, although LEAs in people with type 1 diabetes fell, type 2 LEAs increased.…”

Section: Chapter 1 Backgroundmentioning

confidence: 99%

A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS)

Crawford

Cézard

Chappell

et al. 2015

Health Technol Assess

158

196

View full text Add to dashboard Cite

BackgroundAnnual foot risk assessment of people with diabetes is recommended in national and international clinical guidelines. At present, these are consensus based and use only a proportion of the available evidence.ObjectivesWe undertook a systematic review of individual patient data (IPD) to identify the most highly prognostic factors for foot ulceration (i.e. symptoms, signs, diagnostic tests) in people with diabetes.Data sourcesStudies were identified from searches of MEDLINE and EMBASE.Review methodsThe electronic search strategies for MEDLINE and EMBASE databases created during an aggregate systematic review of predictive factors for foot ulceration in diabetes were updated and rerun to January 2013. One reviewer applied the IPD review eligibility criteria to the full-text articles of the studies identified in our literature search and also to all studies excluded from our aggregate systematic review to ensure that we did not miss eligible IPD. A second reviewer applied the eligibility criteria to a 10% random sample of the abstract search yield to check that no relevant material was missed. This review includes exposure variables (risk factors) only from individuals who were free of foot ulceration at the time of study entry and who had a diagnosis of diabetes mellitus (either type 1 or type 2). The outcome variable was incident ulceration.ResultsOur search identified 16 cohort studies and we obtained anonymised IPD for 10. These data were collected from more than 16,000 people with diabetes worldwide and reanalysed by us. One data set was kept for independent validation. The data sets contributing IPD covered a range of temporal, geographical and clinical settings. We therefore selected random-effects meta-analysis, which assumes not that all the estimates from each study are estimates of the same underlying true value, but rather that the estimates belong to the same distribution. We selected candidate variables for meta-analysis using specific criteria. After univariate meta-analyses, the most clinically important predictors were identified by an international steering committee for inclusion in the primary, multivariable meta-analysis. Age, sex, duration of diabetes, monofilaments and pulses were considered most prognostically important. Meta-analyses based on data from the entire IPD population found that an inability to feel a 10-g monofilament [odds ratio (OR) 3.184, 95% confidence interval (CI) 2.654 to 3.82], at least one absent pedal pulse (OR 1.968, 95% CI 1.624 to 2.386), a longer duration of a diagnosis of diabetes (OR 1.024, 95% CI 1.011 to 1.036) and a previous history of ulceration (OR 6.589, 95% CI 2.488 to 17.45) were all predictive of risk. Female sex was protective (OR 0.743, 95% CI 0.598 to 0.922).LimitationsIt was not possible to perform a meta-analysis using a one-step approach because we were unable to procure copies of one of the data sets and instead accessed data via Safe Haven.ConclusionsThe findings from this review identify risk assessment procedures that can reliably inform national and international diabetes clinical guideline foot risk assessment procedures. The evidence from a large sample of patients in worldwide settings show that the use of a 10-g monofilament or one absent pedal pulse will identify those at moderate or intermediate risk of foot ulceration, and a history of foot ulcers or lower-extremity amputation is sufficient to identify those at high risk. We propose the development of a clinical prediction rule (CPR) from our existing model using the following predictor variables: insensitivity to a 10-g monofilament, absent pedal pulses and a history of ulceration or lower-extremities amputations. This CPR could replace the many tests, signs and symptoms that patients currently have measured using equipment that is either costly or difficult to use.Study registrationThis study is registered as PROSPERO CRD42011001841.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

Reduced Incidence of Lower-Extremity Amputations in People With Diabetes in Scotland

Cited by 95 publications

References 15 publications

Predictors of Lower-Extremity Amputation in Patients With an Infected Diabetic Foot Ulcer

Predictors of Lower-Extremity Amputation in Patients With an Infected Diabetic Foot Ulcer

Diabetic foot infections and management: A Rural Indian Perspective

A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS)

Contact Info

Product

Resources

About