Risk factors for lower extremity amputation among patients with diabetes in Singapore

Yang, Yong; Østbye, Truls; Tan, Say Beng; Salam, Zakir-Hussain Abdul; Ong, Biauw Chi; Yang, Kok Soong

doi:10.1016/j.jdiacomp.2011.08.002

Cited by 39 publications

(49 citation statements)

References 43 publications

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“…(6,9) The study by Yang et al observed that being of an older age group (> 65 years) is a significant factor for lower extremity amputation in diabetic patients with renal disease. (10) In the present study, age was not found to be a significant predictive factor for major lower limb amputation. We also noted that only 101 (46.3%) patients were living with their spouses and 18 (8.3%) patients were living alone.…”

Section: Discussioncontrasting

confidence: 62%

“…However, another study that was also conducted in Singapore found that patients of Malay ethnicity were more likely to have lower extremity amputations as compared to patients of Chinese or Indian ethnicities. (10) In the present study, a duration of T2DM of ≥ 10 years was found to be a significant independent predictive factor for major lower limb amputation. This finding was also observed by Lehto et al, and Selby and Zhang.…”

Section: Discussionsupporting

confidence: 54%

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Predictors of major lower limb amputation in children presenting to a single tertiary centre with perceived or true food allergies

Yusof

Rahman

Zulkifly

et al. 2015

smedj

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INTRODUCTION Diabetes mellitus (DM) is the most common cause of amputations in Malaysia. This study aimed to identify the predictive factors for major lower limb amputation among patients with type 2 DM (T2DM) who were admitted to a hospital, in order to reduce its likelihood. METHODSThis cross-sectional study involved 218 patients with T2DM who were admitted to Hospital Tengku Ampuan Afzan, Kuantan, Malaysia, for diabetic foot problems from June 2011 to July 2012. A form was developed to document the patients' profiles, comorbidities, complications, investigations, treatment and clinical outcomes. The predictors for major lower limb amputations were determined using univariate and stepwise logistic regression analysis. RESULTSA total of 31 patients underwent major lower limb amputations (25 transtibial, 6 transfemoral). The following factors were found to be associated with the incidence of major lower limb amputations: T2DM duration ≥ 10 years, diabetic neuropathy, diabetic nephropathy, presentation with gangrene, diabetic foot conditions of Wagner grade 4 or 5, and necrotising fasciitis. Patients who underwent major amputations had significantly lower haemoglobin and albumin levels, and higher total white blood cell counts, erythrocyte sedimentation rates, and C-reactive protein, urea and creatinine levels. However, only T2DM duration ≥ 10 years, positive bacterial culture and albumin levels were significant on stepwise logistic regression analysis.CONCLUSION T2DM duration ≥ 10 years, positive bacterial culture and low albumin levels were found to be significant predictive factors for major lower limb amputation among patients with T2DM admitted for diabetic foot problems.

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Section: Discussioncontrasting

confidence: 62%

Section: Discussionsupporting

confidence: 54%

Predictors of major lower limb amputation in children presenting to a single tertiary centre with perceived or true food allergies

Yusof

Rahman

Zulkifly

et al. 2015

smedj

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“…Rapid progression of PAD was found in hemodialysis Taiwanese patients, and the prevalence of ABI <0.9 increased yearly (10.4%, 22.7% and 27.9%, respectively; p < 0.001) [23]. Another retrospective study of a Singapore hospital discharge database (2004–2009) noted that DM patients with renal disease had significantly higher rates of lower extremity amputation (7.1%) compared to DM patients without renal disease (2.5%, p < 0.001) [24]. In the present study, gender, various age strata and co-morbidity (including diabetes, hypertension, ESRD, cardiovascular disease (CAD), hyperlipidemia and an integrated co-morbidity index) were found to have significant effects on the performance of different invasive treatment methods for hospitalized PAD cases in Taiwan.…”

Section: Discussionmentioning

confidence: 99%

Invasively-treated incidence of lower extremity peripheral arterial disease and associated factors in Taiwan: 2000–2011 nationwide hospitalized data analysis

Chang

Chan

et al. 2013

BMC Public Health

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BackgroundLower extremity (LE) peripheral artery disease (PAD), which is associated with a reduced quality of life and increased mortality from atherosclerotic cardio-/cerebro-vascular occlusion, is a significant public health problem, especial for an aging society such as that of Taiwan.MethodsSpecific datasets of the 2000–2011 nationwide inpatient databases were analyzed. Two inclusion criteria, including one of the major diagnosis codes of PAD and one of three categorical invasive treatments of LE PAD, were used consecutively to select cases diagnosed as LE PAD and receiving invasive treatment. The epidemiology of invasively-treated PAD in Taiwan was estimated, and the influences of potential confounders on these invasively-treated methods were evaluated.ResultsIn general, the invasively-treated incidence of PAD in Taiwan doubled, from 3.73/10,000 (in 2000) to 7.48/10,000 (in 2011). On average, the total direct medical cost of one hospitalized and invasively-treated PAD case ranged from $US 4,600 to $US 5,900. The annual cases of bypass surgery for the PAD cases averaged 1,000 and the cases for limb amputation ranged from 4,100 to 5,100 annually. However, the number of percutaneous transluminal angioplasty (PTA) procedures remarkably increased by 15 times, from 600/year to 9,100/year, from 2000 to 2011. 51.3% of all the enrolled cases were treated with limb amputations, and female, young and middle-aged people (30–65 years of age), DM patients and those on a low income had a tendency to undergo amputation due to PAD. 37.6% of all the enrolled cases were treated with PTAs related to hypertension, cardiovascular disease, hyperlipidemia and catastrophic Illness. 2-year PTA failure rates of 22.13%, 11.91% and 10.61% were noted among the first (2000–2001), second (2004–2005) and the third (2008–2009) cohort groups, respectively.ConclusionsIn Taiwan, a gender difference and age and period effects on the invasively-treated incidence of LE PAD were observed. Female, young and middle-aged people (30–50 and 50–65 years of age), DM patients and those on a low income had a tendency to undergo amputation. The number of PTA procedures remarkably increased, but the 2-year failure rate of PTAs reduced from 2000 to 2011.

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“…In a study in Singapore, 3.2% of diabetic patients admitted to the largest tertiary hospital underwent LEAs. 23 Other studies have reported a low rate of LEAs among diabetic patients of East Asian ethnicity. 24,25 …”

Section: Discussionmentioning

confidence: 94%

Cardiovascular Autonomic Dysfunction Predicts Diabetic Foot Ulcers in Patients With Type 2 Diabetes Without Diabetic Polyneuropathy

et al. 2016

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We investigated the factors that might influence the development of diabetic foot ulcers (DFUs) in type 2 diabetes patients without diabetic polyneuropathy (DPN).From January 2000 to December 2005, a total of 595 patients who had type 2 diabetes without DPN between the ages of 25 and 75 years, and had no prior history of DFUs were consecutively enrolled in the study. A cardiovascular autonomic function test was performed to diagnose cardiovascular autonomic neuropathy (CAN) using heart rate variability parameters.The median follow-up time was 13.3 years. Among the 449 (75.4%) patients who completed the follow-up evaluation, 22 (4.9%) patients developed new ulcers, and 6 (1.3%) patients underwent the procedure for lower extremity amputations. The patients in the DFUs group had a longer duration of diabetes, higher baseline HbA1c levels, higher rates of nephropathy, and CAN. A Cox hazard regression analysis results revealed that the development of DFUs was significantly associated with the presence of CAN (normal vs definite CAN; HR, 4.45; 95% confidence interval, 1.29–15.33) after adjusting for possible confounding factors.The development of DFUs was independently associated with CAN in patients with type 2 diabetes without DPN. We suggested the importance of CAN as a predictor of DFUs even in the patients without DPN, and the need to pay attention to patients with definite CAN and type 2 diabetes.

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Risk factors for lower extremity amputation among patients with diabetes in Singapore

Cited by 39 publications

References 43 publications

Predictors of major lower limb amputation in children presenting to a single tertiary centre with perceived or true food allergies

Predictors of major lower limb amputation in children presenting to a single tertiary centre with perceived or true food allergies

Invasively-treated incidence of lower extremity peripheral arterial disease and associated factors in Taiwan: 2000–2011 nationwide hospitalized data analysis

Cardiovascular Autonomic Dysfunction Predicts Diabetic Foot Ulcers in Patients With Type 2 Diabetes Without Diabetic Polyneuropathy

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