The predictive role of inpatient hypoglycemia for amputations in patients with acute diabetic foot

Abstract

In Nov 2019, The Journal of Clinical Endocrinology & Metabolism published an article Association of inpatient glucose measurements with amputations in patients hospitalized with acute diabetic [Peled S, Pollack R, Elishoov O, et al. J Clin Endocrinol Metab, 2019, 104(11): 5445-5452. DOI: 10.1210/jc.2019-00774], with the permission of the original journal, we translated it into Chinese. This article studied the relationship of glycemic indices during hospitalization with amputations in patients with acute diabetic foot. The retrospective cohort study included 418 patients admitted with acute diabetic foot in the diabetic foot unit during 2015-2017. Information on demographic characteristics, medical history, laboratory tests, and point-of-care glucose measurements were collected. The primary outcomes were any or major amputation during hospitalization. 45 496 glucose measurements were taken for 418 patients hospitalized with acute diabetic foot. Patients experiencing any hyperglycemia and any or severe hypoglycemia were more likely to undergo any or major amputations during hospitalization. High glycemic variability was associated with major amputations. Peripheral vascular disease, high Wagner score, and hypoglycemia were independent predictors of amputations. Older age, peripheral vascular disease, previous amputation, elevated white blood cell, high Wagner score, and hypoglycemia were independent predictors of major amputations. Hypoglycemia appeared to be an independent risk factor for any and major amputations. While it is unclear whether hypoglycemia directly contributes to adverse outcomes, efforts to minimize in-hospital hypoglycemic events are needed. Key words: Hyperglycemia; Hypoglycemia; Glucose variability; Amputations; Diabetic foot