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Lower-extremity amputations in NIDDM. 12-yr follow-up study in Pima Indians
R G Nelson1, D M Gohdes, J E Everhart
1Diabetes and Arthritis Epidemiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona.
Diabetes Care
|January 1, 1988
Summary
Lower-extremity amputations are high in Pima Indians with non-insulin-dependent diabetes mellitus (NIDDM). Risk factors include diabetes duration, complications, and hyperglycemia, leading to increased cardiovascular deaths.
Area of Science:
- Epidemiology
- Diabetology
- Vascular Surgery
Background:
- Pima Indians have a high prevalence of non-insulin-dependent diabetes mellitus (NIDDM).
- Lower-extremity amputations are a serious complication of diabetes.
- Understanding amputation incidence and risk factors is crucial for prevention.
Purpose of the Study:
- To estimate the incidence of lower-extremity amputations in Pima Indians with NIDDM.
- To identify risk factors associated with these amputations.
- To assess the mortality and cardiovascular impact of amputations in this population.
Main Methods:
- Prospective cohort study of 4399 Pima Indians from 1972-1984.
- Analysis of amputation incidence, patient demographics, and clinical data.
- Comparison of mortality rates between diabetic amputees and non-amputees.
Main Results:
- 84 lower-extremity amputations occurred, 95% in patients with NIDDM.
- Higher amputation rates in men vs. women and increased rates with diabetes duration.
- Significant risk factors: medial arterial calcification, retinopathy, nephropathy, neuropathy, and hyperglycemia.
Conclusions:
- Diabetic Pima Indians exhibit a higher incidence of lower-extremity amputations than other populations.
- Diabetes duration, microvascular/macrovascular complications, and glycemic control are key risk factors.
- Amputations in diabetic individuals are associated with increased mortality and cardiovascular events.