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Risk factors predicting lower extremity amputations in patients with NIDDM
S Lehto1, T Rönnemaa, K Pyörälä
1Department of Medicine, Kuopio University Hospital, Finland.
Diabetes Care
|June 1, 1996
Summary
Poor glycemic control and peripheral issues significantly increase lower extremity amputation risk in patients with non-insulin-dependent diabetes mellitus (NIDDM). Early detection of these factors is crucial for prevention.
Area of Science:
- Endocrinology
- Vascular Surgery
- Diabetology
Background:
- Non-insulin-dependent diabetes mellitus (NIDDM) is a leading cause of lower extremity amputation.
- Identifying predictors of amputation is critical for preventative strategies in NIDDM patients.
Purpose of the Study:
- To investigate the key predictors of lower extremity amputation in a cohort of NIDDM patients.
- To establish the relationship between glycemic control, neuropathy, and vascular disease with amputation risk.
Main Methods:
- A 7-year follow-up study involving 1,044 NIDDM patients (aged 45-64 years).
- Baseline assessment of risk factors including glycemic control (fasting plasma glucose, HbA1), peripheral neuropathy signs, and peripheral artery status.
- Amputation incidence was recorded over the follow-up period.
Main Results:
- High fasting plasma glucose and longer diabetes duration were associated with a twofold increased amputation risk.
- Poor glycemic control (HbA1) and hyperglycemia were significant predictors, showing a dose-response relationship.
- Clinical signs of peripheral neuropathy (absent reflexes, impaired vibration sense) and peripheral arterial disease (absent pulses, bruit) were also strong predictors.
Conclusions:
- Poor glycemic control is a primary predictor of lower extremity amputation in NIDDM.
- Clinically evident peripheral arterial disease and neuropathy independently predict amputation risk.
- These findings underscore the importance of managing hyperglycemia and screening for vascular and neurological complications to prevent amputations.