Lower extremity amputations in diabetic patients: a case-control study

Mônica Antar Gamba,Lucila A C Vianna,Sabina Léa Davidson Gotlieb,Denise Pimentel Bergamaschi

doi:10.1590/s0034-89102004000300010

Abstract

Lower extremity amputation is an increasing problem among diabetic patients and an important public health problem. The study purpose was to identify factors associated with lower extremity amputation. A matched case-control study was carried out among diabetic patients. Cases were selected in public health programs of the city of São Paulo, Brazil. One hundred and seventeen cases of diabetics with lower extremity amputation were compared to 234 controls of diabetics without amputation, matched by sex, age, and duration of disease. Sociodemographic variables, life habits (smoking and alcohol drinking), clinical aspects, and health education in diabetes were included. Univariate analyses and conditional logistic regression method were applied to data. Data showed evidence of association for: smoking, last glucose test > or = 200 mg/dl, presence of peripheral somatic neuropathy and vibratory perception (tuning fork 128 Hz), and peripheral vascular disease. Diabetes treatment and attending nursing appointments for diabetes education were important factors for preventing lower extremity amputation in diabetic patients. The knowledge of determinants and intervening factors for this condition will lead to cost reduction and better quality of care delivered in public health services.

Highlights

Diabetes mellitus (DM) is a major public health concern in Brazil and worldwide
The epidemiological impact of diabetes is evidenced by the growing morbidity and mortality rates, and by causing permanent disabilities such as blindness, diabetic retinopathy, end-stage renal failure and lower extremity amputations (LEA) (ADA,1 1999)
This study aims at identifying LEA associated factors in DM patients and determining prevention and intervention measures

Summary

Introduction

Diabetes mellitus (DM) is a major public health concern in Brazil and worldwide. The epidemiological impact of diabetes is evidenced by the growing morbidity and mortality rates, and by causing permanent disabilities such as blindness, diabetic retinopathy, end-stage renal failure and lower extremity amputations (LEA) (ADA,1 1999). In 1995, 10% of diabetes patients in the United States underwent some kind of amputation Of all LEA, 50% is carried out in diabetics. Studies show that 85% of LEA are preceded by foot ulceration (NIH,12 1995; ADA,2 1999). Among risk factors in LEA DM patients are: long duration of the disease, prolonged hyperglycemia, dyslipidemia, smoking and drinking, neuropathy, peripheral vascular disease, and prior ulcers (Reiber,13 1992; LEA,9 1995; Adler et al,4 1999; Moss et al,11 1999)

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