Diabetic amputees in Singapore

Area of Science:

• Clinical Medicine
• Orthopaedics
• Diabetology
• Vascular Surgery

Background:

• Limb amputations are a significant clinical outcome, particularly in patients with diabetes.
• Understanding the primary indications and patient demographics for amputation is crucial for public health.
• Peripheral vascular disease is a known complication of diabetes, often preceding severe limb issues.

Purpose of the Study:

• To analyze the clinical features and primary indications for limb amputations in a Singaporean population.
• To determine the prevalence of peripheral vascular disease in diabetic patients undergoing amputation.
• To identify the most common causes of amputation, with a focus on diabetic complications.

Main Methods:

• Retrospective review of 262 patients undergoing 289 limb amputations between January 1978 and June 1980.
• Categorization of amputations by indication: diabetic complications, trauma, and atherosclerosis.
• Assessment of peripheral vascular disease using ankle/arm systolic blood pressure ratio in affected and remaining limbs.

Main Results:

• Diabetic complications accounted for the majority of amputations (59.2%), followed by trauma (14.9%) and atherosclerosis (9.3%).
• Common diabetic indications included gangrene (36%), ulcer (25%), and infection (14%).
• A high prevalence of peripheral vascular disease was observed in diabetic amputees, with decreased ankle/arm systolic BP ratios noted in affected and contralateral legs.

Conclusions:

• Diabetes is the predominant indication for limb amputation in this cohort, underscoring the severe impact of diabetic complications.
• Peripheral vascular disease is a significant contributing factor to amputations in Type II diabetics.
• Early detection and management of peripheral vascular disease in diabetic patients are critical to reduce amputation rates.