Background
Methods
Profile of study area and population
Data collection
Statistical analysis
Results
Characteristics
Parameters | Combined | Lower Limb Amputation | No Lower Limb Amputation | p-value |
---|---|---|---|---|
(n = 3143) | (n = 78) | (n = 3065) | ||
Gender | ||||
Female, n (%) | 1952 (62.1) | 30 (38.5) | 1922(62.7) |
< 0.001
|
Age, mean ± SD | 59.5 ± 14.6 | 62.2 ± 11.8 | 58.5 ± 14.9 |
0.02
|
Age at diagnosis, mean ± SD | 49.2 ± 11.2 | 46.2 ± 10.2 | 52.2 ± 11.6 |
< 0.001
|
Duration of diabetes | 10.2 ± 5.6 | 10.9 ± 6.8 | 9.6 ± 4.9 | 0.08 |
Location of domicile | 0.29 | |||
Urban | 2567 (81.7) | 52 (56.7) | 2515 (82.1) |
0.002
|
Semi-urban | 409 (13.0) | 8 (10.3) | 401 (13.1) | 0.61 |
Rural | 167 (5.3) | 18 (23.1) | 149 (4.7) |
< 0.001
|
Highest educational attainment |
0.03
| |||
None | 454 (14.3) | 23 (29.5) | 431 (14.1) |
< 0.001
|
Primary | 604 (19.2) | 23 (29.5) | 601 (19.6) |
0.04
|
Secondary | 1389 (44.2) | 26 (33.3) | 1644 (53.6) |
< 0.001
|
Tertiary | 695 (22.1) | 6 (7.8) | 389 (12.7) | 0.23 |
Employment status | ||||
Skilled academic | 298 (9.5) | 21 (26.9) | 277 (9.0) |
< 0.001
|
Manual worker | 1763 (56.1) | 32 (41.0) | 1731 (56.4) |
0.01
|
Retired | 426 (13.6) | 16 (20.5) | 410 (13.4) | 0.09 |
Unemployed | 517 (16.4) | 9 (11.5) | 508 (16.8) | 0.28 |
Duration before referral to Centre, mean ± SD (years) | 3.8 ± 2.5 | 5.4 ± 1.7 | 1.3 ± 2.2 |
0.001
|
Diabetes type | 0.25 | |||
Type 1 | 192 (6.1) | 2 (2.6) | 156 (5.1) | 0.43 |
Type 2 | 2793 (88.9) | 76 (97.8) | 2717 (88.6) |
0.001
|
Others | 168 (5.3) | 0 (0) | 192 (6.3) | – |
Vascular risk factors | ||||
Hypertension, n (%) | 2678 (85.2) | 74 (94.9) | 2604 (84.6) | 0.02 |
Dyslipidemia, n (%) | 1897 (60.4) | 59 (75.6) | 1838 (60.0) | 0.004 |
Cigarette smoking n (%) | 36 (1.1) | 9 (11.5) | 27 (0.9) | 0.84 |
Alcohol Use, n (%) | 756 (24.1) | 18 (23.1) | 738 (24.1) | 0.43 |
Waist-to-Hip ratio, mean ± SD | 0.93 ± 0.09 | 0.95 ± 0.05 | 0.94 ± 0.08 | 0.18 |
Body Mass Index, mean ± SD | 28.0 ± 3.3 | 26.0 ± 3.7 | 27.1 ± 3.6 |
0.007
|
Systolic blood pressure, mmHg | 143 ± 35.1 | 156 ± 43.1 | 130 ± 18.9 |
0.0001
|
Diastolic blood pressure, mmHg | 89.3 ± 23.2 | 96.2 ± 22.1 | 82.4 ± 14.4 |
0.0001
|
Therapy | ||||
Lipid-lowering therapy, n (%) | 1245 (39.6) | 12 (15.4) | 1233 (40.2) |
< 0.0001
|
Antiplatelet therapy, n (%) | 1345 (42.8) | 23 (29.5) | 1322 (43.1) |
0.01
|
ACE/ARB Inhibition, n (%) | 2567 (81.7) | 35 (44.9) | 2532 (80.6) |
< 0.0001
|
Calcium channel blockers, n (%) | 2064 (65.7) | 64 (82.1) | 2000 (65.3) |
< 0.0001
|
Centrally acting agents, n (%) | 478 (15.2) | 13 (16.7) | 465 (15.1) | 0.75 |
Diuretics, n (%) | 1567 (49.9) | 12 (15.4) | 1355 (44.2) |
< 0.001
|
Metformin, n (%) | 2975 (94.7) | 48 (61.5) | 2927 (94.5) |
< 0.001
|
Sulphonylureas, n (%) | 2456 (78.1) | 63 (80.8) | 2393 (78.1) | 0.68 |
DPP4 Inhibitors, n (%) | 102 (3.2) | 1 (1.3) | 101 (3.3) | 0.52 |
Insulin, n (%) | 624 (19.9) | 2 (2.6) | 622 (20.3) |
< 0.001
|
Glycemic control | ||||
Fasting blood glucose (mmol/L) | 8.9 ± 5.2 | 12.6 ± 5.6 | 7.9 ± 4.5 |
< 0.0001
|
HbA1c (%) | 8.1 ± 2.1 | 10.4 ± 3.2 | 7.5 ± 4.2 |
< 0.0001
|
Estimated Glomerular Filtration Rate | 42.2 ± 9.8 | 29.2 ± 6.8 | 66.4 ± 5.6 |
< 0.0001
|
Peripheral sensory neuropathy | 867 (27.6) | 66 (84.6) | 801 (26.1) |
< 0.0001
|
Peripheral Vascular Disease | 87 (2.8) | 26 (33.3) | 61 (2.0) |
< 0.0001
|
Incidence of amputations
Causes of amputations
Types of amputations
Type of Amputation | Total Number (n = 78) | Males (n = 62) | Females (n = 16) |
---|---|---|---|
Major Amputations (n = 53) | |||
Right Above Knee Amputation | 25 (32.0) | 20 (25.6) | 5 (6.4) |
Right below Knee Amputation | 13 (16.7) | 10 (12.8) | 3 (3.8) |
Left Above Knee Amputation | 4 (5.1) | 3 (3.8) | 1 (1.3) |
Left Below Knee Amputation | 4 (5.1) | 4 (6.5) | 0 (0) |
Bilateral Above Knee Amputation | 4 (5.1) | 3 (3.8) | 1 (1.3) |
Bilateral below Knee Amputation | 3 (3.8) | 3 (3.8) | 0 (0) |
Minor Amputations (n = 25) | |||
Right Digital Amputation | 12 (15.3) | 10 (12.8) | 2 (2.6) |
Left digital amputation | 8 (10.3) | 5 (6.4) | 3 (3.8) |
Bilateral Digital Amputation | 5 (6.4) | 4 (6.5) | 1 (1.3) |
Predictors of lower limb amputations
Predictor | Unadjusted HR (95% CI) | P-Value | Adjusted HR (95% CI) | P-Value |
---|---|---|---|---|
Gender | ||||
Male | 5.28 (3.11–8.96) | < 0.001 | 3.50 (2.88–5.23) |
< 0.001
|
Female | 1 | |||
Age at presentation | ||||
10 years’ age increase | 1.40 (1.19–1.65) | < 0.001 | 1.11 (1.06–1.22) |
< 0.001
|
Duration of diabetes | ||||
5 year increase | 2.40 (0.92–3.14) | < 0.07 | – | |
Type of DM | ||||
Type 1 | 1 | 1 | ||
Type 2 | 6.20 (3.13–9.43) | < 0.001 | 8.21 (2.58–10.7) |
< 0.001
|
Specific type | 0.50 (0.32–1.21) | 0.32 | ||
Body mass index | ||||
Each 5 kg/m2 increase | 5.3 (3.11–8.96) | < 0.001 | 3.2 (2.51–7.25) |
< 0.001
|
Glycemic control | ||||
A percentage increase in HbA1c | 1.23 (1.08–1.42) | 0.003 | 1.11 (1.05–1.25) | 0.03 |
Dyslipidaemia | ||||
Present | 0.84 (0.51–1.36) | 0.47 | – | – |
Absent | 1 | |||
Complications | ||||
Hypertension | 1.51 (1.02–1.71) | < 0.001 | 1.14 (1.12–3.21) |
< 0.001
|
Nephropathy | 1.6 (0.8–2.3) | 0.07 | – |
–
|
A 10/mL/min/1.73 m 2 drop in eGFR | ||||
Peripheral sensory neuropathy | 7.28 (6.38–9.21) | < 0.001 | 6.56 (6.21–8.52) |
< 0.001
|
Peripheral Vascular Disease | 9.76 (5.67–12.21) | < 0.001 | 7.73 (4.39–9.53) |
< 0.001
|