Abstract
AimsTo analyze the association between demographic, socioeconomic, clinical, epidemiological, and primary healthcare factors with the severity of lower limb amputations (LLAs) in individuals with type II diabetes mellitus (DM-II) at a reference hospital in Fortaleza, Ceará, in Northeast Brazil. MethodsA cross-sectional study was performed with a representative sample of individuals hospitalized with DM-II and the degree of LLA severity: (1) toes; (2) transmetatarsal or infrapatellar; (3) suprapatellar; (4) disarticulation or bilateral. Potentially associated factors with the outcome degree of amputation severity were identified in a semi-structured evaluation during hospitalization. The prevalence ratios of the degree of amputation severity as a function of associated factors were calculated with robust variance Poisson regression models. ResultsThe prevalence of high degree of severity in amputations (suprapatellar, with disarticulation or bilateral) was high in the total sample of 385 patients, revealing to be 49% (187/385). Prevalence ratios (PR) indicated a higher prevalence of DM-II amputation severity in patients who lacked of specific guidance on DM-II amputation in primary care (PR = 1.52, 95% CI: 1.05–2.21). ConclusionsLLAs in DM-II were associated with age above 67 years, male gender, cardiovascular disease, and low support for guidance at the primary healthcare level.
Highlights
Diabetes mellitus (DM) is one of the most prevalent chronic diseases worldwide, and an estimated 415 million people were diagnosed with DM in 2015 [1]
The study was conducted with a cross-sectional epidemiological design and a sampling plan defined by a reference hospital in the city of Fortaleza, Ceara, Northeast Brazil with a representative sample of individuals hospitalized with DM-II and lower limb amputation (LLA)
Eligible patients with diabetes mellitus who underwent lower limb amputation were serially listed during the cumulative sampling until the pre-determined minimum sample size was reached
Summary
Diabetes mellitus (DM) is one of the most prevalent chronic diseases worldwide, and an estimated 415 million people were diagnosed with DM in 2015 [1]. Increasing population aging associated with lifestyle changes contributes to the exponential increase in disease prevalence. Projections for 2030 and 2040 indicate increases of up to 50% in world prevalence with estimates of affected individuals between 439-642 million [2, 3, 4]. In the Northeast region of Brazil, Flor and Campos (2017) [7] identified a self-reported prevalence of 6% considering all age groups. DM accounted for 21% of all deaths reported in the Ceara State Epidemiological Bulletin of Non-Communicable Diseases (NCDs) in 2017 [8]. The mortality rate for DM recorded in DATASUS in 2017 in Ceara was 25 per 100,000 inhabitants [9]
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