RISK-FACTORS FOR AMPUTATION IN DIABETIC-PATIENTS - A CASE-CONTROL STUDY

Background: The objective was to quantify risk factors for lower extre mity amputation in patients with diabetes mellitus in an attempt to pr event amputation. Methods: This investigation was conducted as a case control study among diabetic males from 30 - 90 years of age with an a verage clinical duration of diabetes of 10 years: included were 80 cas es which required a supracondyle amputation associated with diabetes m ellitus, and 240 controls without injuries in the lower extremities. M easurements included the following: socioeconomic level, psychosocial risk factors, neuropathics, peripheral vascular factors, high blood pr essure, smoking; environmental factors, health care, self care, and nu tritional and metabolic factors in patients with diabetes mellitus bef ore surgery. Statistically significant risk factors identified from an alyses were: absence of lower leg vibratory perception (odds ratio = 1 4.9, 95% CI: 8.2 - 27.9); peripheral vascular disease (OR = 8.9, 95% C I: 5.3 - 15.9); high blood cholesterol >450 mg (OR = 3.8, 95% CI:2.9 - 8.6); low blood albumin <3.5 g (OR = 7.9, 95% CI: 4.8 - 14.9); hyperu rea blood nitrogen >3.5 mg(OR = 3.1, 95% CI: 1.7 - 4.9); obesity (OR = 4.2, 95% CI: 1.51 - 9.8); time of evolution of diabetes mellitus >10 years (OR = 3.47, 95% CI: 1.40 - 8.56); cracks in feet (OR = 3.45, 95% CI: 1.33 - 8.82); feet soaked in water (OR = 1.8, 95% CI: 1.07 - 2.93 ); ingrown toenails (OR = 2.0, 95 % CI: 0.6 - 5.3), and lack of outpat ient diabetes education (OR = 3.2, 95% CI: 1.5 - 6.7). Conclusions: Di fferent risk factors for lower extremity amputation in diabetes mellit us patients were quantified, identifying certain aspects of preventive impact (patient education, glycemic control, careful daily foot hygie ne, and appropriate footwear) which may be applicable in environmental factors and which have the possibility of success in lowering the rat e of risk for lower extremity amputation.