Risk of diabetes‐related amputation in South Asians vs. Europeans in the UK

Chaturvedi, Nish; Abbott, Caroline A.; Whalley, A; Widdows, P.; Leggetter, Sandra; Boulton, Andrew J.M.

doi:10.1046/j.1464-5491.2002.00583.x

Cited by 86 publications

(72 citation statements)

References 17 publications

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“…Table I indicates the basic information of the studies involved in the meta-analysis. The enrolled eight studies included five cohort studies (22)(23)(24)26,27) and three case control studies (20,21,25). The publication year ranged from 1992-2015.…”

Section: Resultsmentioning

confidence: 99%

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Smoking increases the risk of diabetic foot amputation: A meta-analysis

et al. 2017

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Abstract. Accumulating evidence suggests that smoking is associated with diabetic foot amputation. However, the currently available results are inconsistent and controversial. Therefore, the present study performed a meta-analysis to systematically review the association between smoking and diabetic foot amputation and to investigate the risk factors of diabetic foot amputation. Public databases, including PubMed and Embase, were searched prior to 29th February 2016. The heterogeneity was assessed using the Cochran's Q statistic and the I 2 statistic, and odds ratio (OR) and 95% confidence interval (CI) were calculated and pooled appropriately. Sensitivity analysis was performed to evaluate the stability of the results. In addition, Egger's test was applied to assess any potential publication bias. Based on the research, a total of eight studies, including five cohort studies and three case control studies were included. The data indicated that smoking significantly increased the risk of diabetic foot amputation (OR=1.65; 95% CI, 1.09-2.50; P<0.0001) compared with non-smoking. Sensitivity analysis demonstrated that the pooled analysis did not vary substantially following the exclusion of any one study. Additionally, there was no evidence of publication bias (Egger's test, t=0.1378; P=0.8958). Furthermore, no significant difference was observed between the minor and major amputation groups in patients who smoked (OR=0.79; 95% CI, 0.24-2.58). The results of the present meta-analysis suggested that smoking is a notable risk factor for diabetic foot amputation. Smoking cessation appears to reduce the risk of diabetic foot amputation.

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Section: Resultsmentioning

confidence: 99%

“…Following the reading of the full text of the remaining 47 articles, 39 articles were excluded, including six reviews, 22 articles in which the data could not be extracted and 11 articles with duplicated populations. Finally, eight documents were included in this meta-analysis (23)(24)(25)(26)(27)(28)(29)(30).…”

Section: Resultsmentioning

confidence: 99%

Smoking increases the risk of diabetic foot amputation: A meta-analysis

et al. 2017

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“…Studies from the UK suggest that foot ulcers and amputations are less common in Asian patients of Indian subcontinent origin [24,25], whereas Afro-Caribbean males, but not females, have lower amputation rates [26]. Possible explanations for the findings in Asian patients relate to differences in limited joint mobility, and to better foot care in certain religious groups such as Muslims.…”

Section: Epidemiologymentioning

confidence: 99%

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

2004

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Diabetic foot ulceration represents a major medical, social and economic problem all over the world. While more than 5% of diabetic patients have a history of foot ulceration, the cumulative lifetime incidence may be as high as 15%. Ethnic differences exist in both ulcer and amputation incidences, with both being less common in patients of Indian subcontinent origin living in the UK. Foot ulceration results from the interaction of several contributory factors, the most important of which is neuropathy. With respect to the management of acute Charcot neuroarthropathy in diabetes, recent studies suggest that bisphosphonates reduce disease activity as judged not only by differences in skin temperature, but also by assessing markers of bone turnover. The use of the total-contact cast is demonstrated in the treatment of acute Charcot feet and of plantar neuropathic ulcers. Histological evidence suggests that pressure relief results in chronic foot ulcers changing their morphological appearance by displaying some features of an acute wound. Thus, repetitive stresses on the insensate foot appear to play a major role in maintaining ulcer chronicity. It is hoped that increasing research activity in foot disease will ultimately result in fewer ulcers and less amputation in diabetes.

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“…Such factors may contribute to reported differences between the incidence of amputation in the US (where amputation in more common in those of AfroCaribbean origin) and the UK (where it is less common in those of Afro-Caribbean origin, especially in men) [32]. Racial differences in the incidence of amputation between Caucasians and South Asians in the UK have been shown to be entirely attributable to differences in smoking and the prevalence of peripheral vascular disease and neuropathy [32,33].…”

Section: Factors Influencing the Incidence Of Amputationmentioning

confidence: 99%

Amputation as a marker of the quality of foot care in diabetes

2004

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Strategic targets for the management of foot ulcers focus on reducing the incidence of amputation. While data on the incidence of amputation can be obtained relatively easily, the figures require very careful interpretation. Variation in the definition of amputation, population selection and the choice of numerator and denominator make comparisons difficult. Major and minor amputation have to be distinguished as they are undertaken for different reasons and are associated with different costs and functional implications. Many factors influence the decision of whether or not to remove a limb. In addition to disease severity, co-morbidities, and social and individual patient factors, many aspects of the structure of care services affect this decision, including access to primary care, quality of primary care, delays in referral, availability and quality of specialist resources, and prevailing medical opinion. It follows that a high incidence of amputation can reflect a higher disease prevalence, late referral, limited resources, or a particularly interventionist approach by a specialist team. Conversely, a low incidence of amputation can indicate a lower disease prevalence or severity, good management of diabetes in primary and secondary care, or a particularly conservative approach by an expert team. An inappropriately conservative approach could conceivably enhance suffering by condemning a person to months of incapacity before they die with an unhealed ulcer. The reported annual incidence of major amputation in industrialised countries ranges from 0.06 to 3.83 per 10 3 people at risk. Some centres have documented that the incidence is falling, but this is often from a baseline value that was unusually high. Other centres have reported that the incidence has not changed. The ultimate target is to achieve not only a decrease in incidence, but also a low overall incidence. This must be accompanied by improvements in morbidity, mortality, and patient function and mood.

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Risk of diabetes‐related amputation in South Asians vs. Europeans in the UK

Cited by 86 publications

References 17 publications

Smoking increases the risk of diabetic foot amputation: A meta-analysis

Smoking increases the risk of diabetic foot amputation: A meta-analysis

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

Amputation as a marker of the quality of foot care in diabetes

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