Risk factors predicting lower extremity amputations in patients with NIDDM.

Abstract:

OBJECTIVE:To examine the predictors of lower extremity amputation in patients with NIDDM. RESEARCH DESIGN AND METHODS:At baseline, risk factors for amputation were determined in 1,044 NIDDM patients (571 men, 473 women) aged 45 to 64 years. These patients were followed up to 7 years with respect to amputation. RESULTS:The incidence of amputation was 5.6% in men and 5.3% in women. High fasting plasma glucose at baseline examination and the duration of diabetes were associated with a twofold risk for amputation. Similarly, glycemic control measured at baseline by HbA1 was an important predictor of amputation. There was a dose-response relationship between plasma glucose or HbA1 and the risk for amputation. The effect of hyperglycemia on the risk of amputation was seen clearly even after the adjustment for other cardiovascular risk factors. Signs of peripheral neuropathy and bilateral absence of Achilles tendon reflexes and vibration sense were important predictors for amputation. Furthermore, absent peripheral artery pulses and femoral artery bruit on auscultation predicted amputation. CONCLUSIONS:Our 7-year follow-up study gives strong evidence that poor glycemic control is an important predictor of amputation in patients with NIDDM in addition to clinically detectable peripheral arterial disease and peripheral neuropathy.

journal_name

Diabetes Care

journal_title

Diabetes care

authors

Lehto S,Rönnemaa T,Pyörälä K,Laakso M

doi

10.2337/diacare.19.6.607

subject

Has Abstract

pub_date

1996-06-01 00:00:00

pages

607-12

issue

6

eissn

0149-5992

issn

1935-5548

journal_volume

19

pub_type

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