Risk factor for amputation in diabetic patients: a case control study

RESUMO

Background. The objective was to quantify risk factors for lower extremity amputation in patients with diabetes mellitus in an attempt to prevent amputation. Methods. This investigation was conducted as a case control study among diabetic males from 30-90 years of age with an average clinical duration of diabetes of 10 years: included were 80 cases which required a supracondyle amputation associated with diabetes mellitus, and 240 controls without injuries in the lower extremities. Measurements included the following: socioeconomic level, psychosocial risk factors, neuropathics, peripheral vascular factors, high blood pressure, smoking; environmental factor, health care, self care, and nutritional and metabolic factors in patients with diabetes mellitus before surgery. Statistically significant risk factors identified from analyses were: absence of lower leg vibratory perception (odds ratio = 14.9, 95 percent CI: 8.2 - 27.9); peripheral vascular disease (OR = 8.9, 95 percent CI: 5.3 - 15.9); high blood cholesterol >450 mg (OR = 3.8, 95 percent CI: 2.9 - 8.6): low blood albumin <3.5 g (OR = 7.9, 95 percent CI: 4.8 - 14.9); hyperurea blood nitrogen >3.5 mg (OR=3.1, 95 percent CI: 1.7 -4.9); obesity (OR=4.2, 95 percent CI: 1.51 -9.8); time of evolution of diabetes mellitus >10 years (OR=3.47, 95 percent CI: 1.40-8.56); cracks in feet (OR= 3.45, 95 percent CI: 1.33-8.82; feet soaked in water (OR=1.8, 95 percent CI: 1.07-2.93); ingrown toenails (OR=2.0, 95 percent CI: 0.6 -5.3), and lack of outpatient diabetes education (OR=3.2, 95 percent CI: 1.5- 6.7). Conclusiones. Different risk factor for lower extremity amputation in diabetes mellitus patients were quantified, identifiying certain aspects of preventive impact (patients education, glycemic control, careful daily foot hygiene, and appropriate footwear) which may be applicable in envinronmental factors and which have the possibility jof succes in lowering the rate of risk for lowering the rate of risk for lower extremity amputation