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Distance as a risk factor for amputation in patients with diabetes: a case-control study
Irish Medical Journal
|May 20, 2014
Summary
Patients living further from diabetes centers face higher amputation risks, especially those with neuropathy. This highlights the need for accessible diabetes care to prevent lower limb amputations.
Area of Science:
- Endocrinology and Metabolism
- Vascular Surgery
- Public Health
Background:
- Diabetes mellitus is a leading cause of lower limb amputations worldwide.
- Geographic accessibility to specialized diabetes care centers may influence patient outcomes.
- Understanding factors associated with amputation risk is crucial for preventative strategies.
Purpose of the Study:
- To investigate the association between residential distance from diabetes care centers and lower limb amputation risk.
- To identify key predictors of amputation in diabetic patients, considering geographic and clinical factors.
Main Methods:
- A case-control study was conducted, matching 66 amputation cases with 313 controls (no amputation) by age and sex.
- Comparison of residence distance to diabetes centers, diabetes duration, type, HbA1c levels, and foot examination findings.
- Multivariate analysis was used to determine significant predictors of amputation.
Main Results:
- Amputation cases resided significantly farther (12.1 km greater) from diabetes care centers compared to controls (p = 0.028).
- Diabetes duration (OR/year 1.07) and neuropathy (OR 10.73) were the strongest independent predictors of amputation.
- Patients with neuropathy lived substantially farther (97 km) from centers than those without (p = 0.01).
Conclusions:
- Increased distance to diabetes care centers is associated with a higher risk of lower limb amputation.
- Neuropathy and longer diabetes duration are critical risk factors, potentially exacerbated by geographic barriers to care.
- Improving access to diabetes care may reduce amputation rates, particularly for patients with neuropathy.
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