Risk Factors Predicting Lower Extremity Amputations in NIDDM Patients

Lee, Tai Hee; Park, Jae Hong; Kim, Myung Soo; Kim, Jung Min; Kim, Ji Youn; Park, Chang Hwan; Kim, Yong Joo; Lee, Dae Bae; Yang, Seung Won; Chung, Dong Jin; Chung, Min Young

Abstract

OBJECTIVE
To quantify the contribution of various risk factors, and to identify predictors of lower extremity amputation(LEA) in NIDDM patients.
PATIENTS AND METHODS
Eligible subjects with NIDDM were 45 to 80 years of age, and had at least one examination in our hospital. Cases had initial amputation of the affected lower extremity for nontraumatic indications between 1990-1995. Controls were NIDDM patients without amputation by 1995. Data on health status, foot condition, glycemic index, chronic diabetic complication and other cardiovascular risk factor prior to the pivotal event that led to the LEA were obtained by medical review.
RESULTS
We identified 29 cases with LEA and randomly selected 397 controls for comparison. Men were more likely to suffer amputation (odds ratio[OR] 2.1, 95% CI 1.2-4.6). The risk factors for amputation in NIDDM subjects were investigated by calculating age- and sex- adjusted ORs for different cardiovascular risk factors by logistic regression analysis. Peripheral vascular disease (OR 22.2, 95.5% CI 6.9-71) and peripheral neuropathy (OR 12.5, 95% CI 5.6-52) were important predictors of amputation.
CONCLUSION
This study gives evidence that poor glycemic control, duration of diabetes and microvascular complication of eye and kidney, are important predictors of amputation in patients with NIDDM, in addition to clinically detectable peipheral vascular disease and peripheral neuropathy. Therefore this study shows that the achievement of good metabolic control is likely to decrease the risk for amputation in patients with NIDDM.