Treatment and outcomes of diabetic muscle infarction

Diabetic patients can develop spontaneous infarctions of muscle. The optimal treatment of this diabetic muscle infarction (DMI) is unknown.

This analysis was conducted to compare the outcomes of conservative, medical, and surgical treatments of DMI. The primary outcome is the time to recovery. Secondary outcomes include recurrence and mortality rates.

A MEDLINE search from its inception to December 2002 was used to identify reported cases of DMI. We selected those cases that reported on specified baseline characteristics of the patients, including age, gender, duration of diabetes, type of diabetes, diabetic microvascular and macrovascular complications, and the magnetic resonance imaging or computed tomography findings, the type of therapy provided, the time to recovery of initial muscle infarction, recurrences, and deaths.

A total of 36 references meeting our inclusion criteria were retrieved, describing 49 patients. Thirty-four patients received conservative therapy (bedrest and analgesics), 8 received medical therapy (antiplatelet agents and/or steroids), and 7 had surgical excision of the infarcted muscle. There were no significant differences in baseline characteristics. The time to recovery from treatment onset was 8.1 weeks, 5.5 weeks, and 13 weeks in the conservative, medical, and surgical treatment groups, respectively. This was statistically significant only when comparing medical and surgical treatment. The respective recurrence rates were 35%, 29%, and 71%. The respective mortality rates within 2 years were 4%, 14%, and 29%.

This study supports the use of nonsurgical treatment in patients with DMI. It also demonstrates that DMI can be temporally associated with death.