RISK-FACTORS FOR LOWER-LIMB COMPLICATIONS IN DIABETIC-PATIENTS

Diabetic lower extremity complications may be influenced by a number o f factors, including those related to the interaction between patients and the health-care system. Oar objective is to identify risk factors for the development of lower limb complications, by looking for class ical clinical variables and those related to duality of care, A case-c ontrol study was carried out between December 1993 and June 1994 by in terviewing 348 patients with lower-limb diabetic complications and 105 0 controls enrolled from 35 diabetes outpatient clinics and 49 general practitioner's offices in Italy. Among sociodemographic characteristi cs associated with increased risk of lower limb complications were mal e gender [odds ratio (OR) = 2.5, confidence interval (CI) 1.6-3.9], ag e between 50 and 70 years as opposed to younger than 50 (OR = 3.6, CI 2.1-6.3) and being single as opposed to married (OR = 1.4, CI 1.1-1.8) . Among clinical variables, treatment with insulin for IDDM and NIDDM patients was an important predictor of lower extremity complications c ompared to NIDDM patients not being treated with insulin, Cardio-cereb rovascular disease and presence of diabetic neuropathy were associated with a higher risk of being a case (OR = 1.4, CI 1.2-1.8 and OR = 3.0 , CI 2.1-4.2, respectively). Patients who needed help to reach the hea lth facility before the onset oi: the complications and those who did not attend health facilities regularly were more liable to develop com plications (OR = 1.5, CI 1.1-2.2 and OR = 2.0, CI 1.3-3.0, respectivel y). Patients who had never received educational intervention had a thr eefold risk of being a case as compared to those who received health i nformation regularly. The study identifies factors most likely to be r elated to adverse outcome and permits to discriminate between avoidabl e and unavoidable factors. (C) 1998 Elsevier Science Inc.