Scoping Review of Risk Factors for Lower Extremity Amputation in Patients with Concomitant Diabetes Mellitus and...

Patients with concomitant diabetes mellitus (DM) and peripheral arterial disease (PAD) represent a high-risk cohort for progression to rest pain, vascular interventions, and lower extremity amputation (LEA). Recent evidence has identified the most significant predictor of LEA in this comorbid population; however, no prior scoping review has mapped the breadth and characteristics of these risk factors. Therefore, we aimed to comprehensively assess the amputation risk profile in patients with DM and PAD.

A scoping review of the PubMed database was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Studies analyzing risk factors for LEA in patients with concomitant DM and PAD were included. Risk factors were extracted and classified by association (positive/negative), modifiability, and frequency of citation.

A total of 335 studies were assessed. After review, 36 studies were included and 196 unique amputation risk factors were identified. There were 45 risk factors significant on multivariate analysis, with 11 cited twice or more. Frequently cited, modifiable risk factors that increased the risk of LEA included HbA1c and insulin use, while nonmodifiable risk factors included age, Black race, chronic kidney disease, C-reactive protein, end-stage renal disease, hemodialysis, and male sex. Total cholesterol and revascularization were modifiable risk factors protective against LEA.

Amputation risk factors for patients with concomitant DM and PAD were categorically summarized. Knowledge of nonmodifiable risk factors may inform counseling and risk stratification efforts. Modifiable, protective risk factors provide opportunity for more multidisciplinary management.