Early Therapeutic Interventions Prevent Amputation Among Patients With Diabetic Foot Syndrome

Diabetic complications are a medical and economic burden on the health system. For patients with type 2 diabetes who are diagnosed with diabetic foot syndrome, early therapeutic intervention is essential to prevent amputation, according to a study published in Primary Care Diabetes.

“There are many studies that look at the risk for lower limb amputation in patients with diabetes compared to non-diabetics; their goal was to display a role of diabetes as a risk factor for lower limb amputations,” Karel Kostev DMs, MA, senior research consultant for the CES LifeLink team at IMS Health GmbH & Co., told O&P Business News. “There were no published studies about the risk for amputations in exactly patients with diabetes and a new diagnosis of diabetic foot syndrome. So the goal of our study was to determine the risk for amputation and the influencing factors for amputation for patients with type 2 diabetes with diabetic foot syndrome.”

Analysis of diabetic foot syndrome

Researchers analyzed longitudinal data from the Disease Analyzer database and found 3,892 patients with type 2 diabetes and a first-time diagnosis of diabetic foot syndrome from 2000 to 2004 with at least 5 years follow-up. Kaplan-Meier curves and log-rank tests were used to analyze amputation-free survival and a multivariate Cox regression model was fitted with the incident of diabetes-associated amputations as the dependent variable and adjusted for clinical and demographic characteristics.

The length of the amputation-free period following the confirmation of a diagnosis of diabetic foot syndrome for patients with type 2 diabetes was considered the primary outcome.

During the study period of 5 years, the cumulative incidence of diabetes-associated lower limb amputation for type 2 diabetes patients was 18.2%. Study results showed that twice as many patients older than 70 years underwent amputation vs. patients younger than 50 years. Men and patients with longer diabetes duration were also at an increased risk for amputation. Researchers found a 20% higher risk for amputation in patients with a mean HbA1c value above 7.5%.

According to multiple Cox regression analyses, the strongest significant independent predictor of amputation for patients with diabetes and diabetic foot syndrome was peripheral artery disease. Another significant risk factor for amputation was diabetic polyneuropathy.

Karel Kostev

Karel Kostev

Use in clinical practice

The results of the database analysis provide “insights into real care practices, as well as valuable supplementary information to epidemiological studies for physicians and health care professionals.”

“After the diagnosis of diabetic foot syndrome, patients and doctors can impact the probability of amputations since patients with good HbA1c values after the diagnosis of diabetic foot syndrome have more than 20% lower risk for amputation than patients with higher HbA1c,” Kostev said. “From other studies we know that, in patients with longer diabetes duration, strict blood sugar control may increase the risk for cardiovascular events. A connection of the amputation rate and HbA1c values can also be seen sooner. But this is new that, even after the diagnosis of diabetic foot syndrome, HbA1c values still play a big role for the next phase of diabetic foot syndrome — namely, lower limb amputation.”

Lifestyle changes, such as eating habits, smoking and physical activity, are also important controls that will help prevent amputation. Physicians should advise patients on how to make these changes before or shortly after they are diagnosed with diabetic foot disease.

“Even if diabetes complication like diabetic foot syndrome is already present, life must go on. It is not too late for the doctor and patient to take care of the patient’s blood glucose control and lifestyle,” Kostev said.

For more information:
Pscherer S, Dippel FW, Lauterbach S, Kostev K. Amputation rate and risk factors in type 2 patients with diabetic foot syndrome under real-life conditions in Germany. Prim Care Diabetes. 2012;6:241-246.

Disclosure: Kostev has no relevant financial disclosures.

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