Sarcopenia increases the risk for mortality in patients who undergo amputation for diabetic foot

Swerdlow

Journal of Foot and Ankle Research

et al. 2020

500

350

Background: In 2007, we reported a summary of data comparing diabetic foot complications to cancer. The purpose of this brief report was to refresh this with the best available data as they currently exist. Since that time, more reports have emerged both on cancer mortality and mortality associated with diabetic foot ulcer (DFU), Charcot arthropathy, and diabetes-associated lower extremity amputation. Methods: We collected data reporting 5-year mortality from studies published following 2007 and calculated a pooled mean. We evaluated data from DFU, Charcot arthropathy and lower extremity amputation. We dichotomized high and low amputation as proximal and distal to the ankle, respectively. This was compared with cancer mortality as reported by the American Cancer Society and the National Cancer Institute. Results: Five year mortality for Charcot, DFU, minor and major amputations were 29.0, 30.5, 46.2 and 56.6%, respectively. This is compared to 9.0% for breast cancer and 80.0% for lung cancer. 5 year pooled mortality for all reported cancer was 31.0%. Direct costs of care for diabetes in general was $237 billion in 2017. This is compared to $80 billion for cancer in 2015. As up to one-third of the direct costs of care for diabetes may be attributed to the lower extremity, these are also readily comparable. Conclusion: Diabetic lower extremity complications remain enormously burdensome. Most notably, DFU and LEA appear to be more than just a marker of poor health. They are independent risk factors associated with premature death. While advances continue to improve outcomes of care for people with DFU and amputation, efforts should be directed at primary prevention as well as those for patients in diabetic foot ulcer remission to maximize ulcer-free, hospital-free and activity-rich days.Up to one-third of the half billion people with diabetes worldwide will develop a diabetic foot ulcer (DFU) over the course of their lifetime. Over half of DFUs will develop an infection. Of these, 17% will require an amputation [1][2][3][4]. Remarkably, people with diabetes fear amputation worse than death [5]. For patients who do not receive amputation and are able to heal their ulcer, 40% will develop a recurrence within 1 year, 65% within 5 years, and greater than 90% within 10 years [1,6]. The greatest risk factor for a DFU is a previously healed DFU. These silent, sinister complications are now a leading cause of disability worldwide [7,8]. Despite this high prevalence and morbidity, federal funding for studies related to DFUs remains at a 600-plus-fold disadvantage compared to other diabetes research in terms of public

Section: The Economic Cost Of Dfusmentioning

confidence: 99%

Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer

Swerdlow

Journal of Foot and Ankle Research

et al. 2020

500

350

“…Currently, there is a lack of evidence to support this statement. Numerous studies have reported that sarcopenia/low muscle mass is related to frailty, 12 inflammation, 13 14 liver fibrosis, 15 16 cirrhosis, 17 18 systemic sclerosis, 19 cancer, 20–22 chronic obstructive pulmonary disease, 23 cardiovascular disease, 24 25 and mortality, 26 all of which place considerable health and economic burdens on public healthcare services. Thus, it is important to depict the prevalence and temporal trends of presarcopenia and related body composition measurements over time in relation to sex, age and race to better inform public health policy and prevention strategies.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and temporal trends of presarcopenia metrics and related body composition measurements from the 1999 to 2006 NHANES

et al. 2020

BMJ Open

ObjectiveTo evaluate the prevalence and temporal trends of presarcopenia and related body composition measurements.DesignCross-sectional study.SettingNational Health and Nutrition Examination Survey (NHANES) 1999–2006.MethodsPresarcopenia was defined according to the guidelines from the European Working Group on Sarcopenia. Logistic or linear regression models were used to evaluate the linear trend of the prevalence of presarcopenia, obesity and related body composition measurements.ParticipantsA total of 29 947 participants aged 18–90 years from five waves of the NHANES were included in the analysis.Outcome measuresPresarcopenia was sex-specifically defined as having a skeletal mass index ≤7.26 kg/m2 in men and ≤5.5 kg/m2 in women. Body composition measurements, including total body fat percentage, total body fat mass, total lean body mass, appendicular skeletal muscle mass and bone mineral density, were obtained by dual-energy X-ray absorptiometry.ResultsThe overall prevalence of presarcopenia ranged from 16.4% in 1999–2000 to 14.8% in 2005–2006 (p for trend=0.78). Presarcopenia was stable in both males (p for trend=0.36) and females (p for trend=0.20). The presarcopenia prevalence was significantly elevated among the age group of 18–39 years old (from 11.3% to 14.1%, p for trend=0.04) and among non-Hispanic blacks (p for trend <0.001). Adults aged ≥80 years old had the highest prevalence.ConclusionsThe prevalence of presarcopenia increased among young individuals over time. Non-Hispanic blacks also demonstrated an increasing trend in the prevalence over time.

“…Those researchers used the dual-energy X-ray absorptiometry (DXA) skeletal muscle index to diagnose sarcopenia. In another Korean study of 414 T2DM patients aged 65 years and older, the risk for low muscle mass was two to four times higher in patients with diabetes than in the control group [28]. In this study, we used BIA, and the prevalence of sarcopenia in all subjects was about 12%.…”

Section: Discussionmentioning

confidence: 95%

“…Although previous studies have suggested that vascular lesions might be associated with sarcopenia, only a few studies have shown that sarcopenia in T2DM patients is related with PAD, CLI, and mortality after leg amputation due to DFD [18,19]. Kim et al [28] showed that the mortality rate in patients with sarcopenia was higher than that in those without sarcopenia in patients who underwent amputation for diabetic foot. These results imply that preventing sarcopenia in patients with diabetes is important for maintaining high survival rates.…”

Section: Discussionmentioning

confidence: 99%

Relationship of Sarcopenia with Microcirculation Measured by Skin Perfusion Pressure in Patients with Type 2 Diabetes

et al. 2020

Background: Few studies have examined the relationship of sarcopenia with the microcirculation. The current study investigated the relationship of sarcopenia with microcirculatory function, as assessed by skin perfusion pressure (SPP), in type 2 diabetes mellitus (T2DM) patients. Methods: In total, 102 T2DM patients who underwent SPP measurements and bioelectrical impedance analysis (BIA) were enrolled in this cross-sectional study. SPP was assessed using the laser Doppler technique. Sarcopenia was defined as low height-adjusted appendicular muscle mass (men, <7 kg/m 2 ; women, <5.7 kg/m 2) using BIA. We divided the participants into two groups based on SPP (≤50 and >50 mm Hg), and an SPP below 50 mm Hg was considered to reflect impaired microcirculation. Results: Fourteen patients (13.7%) were diagnosed with impaired microcirculatory function of the lower limb based on SPP. The prevalence of sarcopenia in all subjects was 11.8%, but the percentage of patients with an SPP ≤50 mm Hg who had sarcopenia was more than triple that of patients with an SPP >50 mm Hg (28.6% vs. 9.1%, P=0.036). A significant positive correlation was found between SPP and appendicular muscle mass adjusted for height (P=0.041 for right-sided SPP). Multiple logistic regression analysis showed that patients with sarcopenia had an odds ratio of 4.1 (95% confidence interval, 1.01 to 24.9) for having an SPP ≤50 mm Hg even after adjustment for confounding factors. Conclusion: These results suggest that sarcopenia may be significantly associated with impaired microcirculation in patients with T2DM. Nonetheless, the small number of patients and wide CI require cautious interpretation of the results.