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These Limb-Specific Factors Predict Amputation

Diabetes Care; ePub 2018 Feb 8; Boyko, et al

Arterial disease and neuropathy were the only limb-specific risk factors that predicted amputation in men with diabetes in a 22-year prospective study involving nearly 1,500 individuals. Participants were males, average age 62 years, who had diabetes and no foot ulcers at baseline. Investigators followed them from 1990 and 2002, collecting demographic, lifestyle, and diabetes characteristics; visual acuity; kidney function; and lower-limb measurements. There were 136 amputations over ~25,700 limb-years. Amputation risk was elevated as follows:

  • Sensory neuropathy: >3-fold.
  • Ankle-brachial index (ABI) ≤0.5 vs. >0.9: nearly 4-fold.
  • ABI ≥1.3 vs. >0.9: >2-fold.
  • 1-standard deviation decrease in estimated glomerular filtration rate: 18%.
  • Poor vision: 70%.

Overall, dorsal foot transcutaneous oximetry was not significantly linked with amputation. But it did serve as a predictor when it was <26 mmHg in in patients with ABI ≥1.3

Citation:

Boyko E, Seelig A, Ahroni J. Limb-and person-level risk factors for lower-limb amputation in the prospective Seattle Diabetic Foot Study. [Published online ahead of print February 8, 2018]. Diabetes Care. doi:10.2337/dc17-2210.

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