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The prevalence and incidence of lower extremity amputation in a diabetic population.
Arch Intern Med 1992; 152(3):610-6AI

Abstract

OBJECTIVE

To describe the incidence of lower extremity amputations and sores or ulcers and investigate risk factors for these complications.

DESIGN

Cohort.

SETTING

Primary care.

PARTICIPANTS

Population-based sample (N = 1210) of younger-onset diabetic persons (diagnosed before age 30 years and taking insulin) and a stratified random sample (N = 1780) of older-onset diabetic persons (diagnosed after age 30 years). Baseline and 4-year follow-up examinations were completed by 996 and 891 younger-onset persons, respectively, and by 1370 and 987 older-onset persons, respectively.

MAIN OUTCOME MEASURES

Amputations and sores or ulcers of the lower extremities.

RESULTS

Four-year incidence of amputations was 2.2% in both groups. Incidence of sores or ulcers was 9.5% in younger-onset and 10.5% in older-onset persons. In younger-onset persons, significant risk factors for amputation with odds ratios (and 95% confidence intervals) include age, 2.0 for 10 years (1.2 to 3.1), history of sores or ulcers, 10.5 (3.7 to 29.8), diastolic blood pressure, 2.1 for 10 mm Hg (1.3 to 3.5), and pack-years smoked, 1.3 for 10 years (1.0 to 1.6). Risk factors for sores or ulcers include glycosylated hemoglobin, 1.6 for 2% (1.3 to 2.0), retinopathy, 1.3 for two steps (1.1 to 1.6), and current smoking, 2.3 (1.0 to 5.6). In older-onset persons, risk factors for amputation are history of sores or ulcers, 4.6 (1.7 to 12.2), proteinuria, 4.3 (1.6 to 11.5), glycosylated hemoglobin, 1.5 for 2% (1.0 to 2.2), sex, 2.8 for males (1.0 to 7.5), and duration of diabetes, 1.8 for 10 years (1.0 to 3.2). For sores or ulcers, risk factors are glycosylated hemoglobin, 1.6 for 2% (1.3 to 2.0), duration, 1.5 for 10 years (1.0 to 2.1), proteinuria, 2.2 (1.1 to 4.3), and diastolic blood pressure, 0.8 for 10 mm Hg (0.6 to 1.0).

CONCLUSIONS

Several factors offer potential for modification for the prevention of amputations but require further study. These include blood pressure, glycosylated hemoglobin, and smoking.

Authors+Show Affiliations

Department of Ophthalmology, University of Wisconsin Medical School, Madison.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

1546925

Citation

Moss, S E., et al. "The Prevalence and Incidence of Lower Extremity Amputation in a Diabetic Population." Archives of Internal Medicine, vol. 152, no. 3, 1992, pp. 610-6.
Moss SE, Klein R, Klein BE. The prevalence and incidence of lower extremity amputation in a diabetic population. Arch Intern Med. 1992;152(3):610-6.
Moss, S. E., Klein, R., & Klein, B. E. (1992). The prevalence and incidence of lower extremity amputation in a diabetic population. Archives of Internal Medicine, 152(3), pp. 610-6.
Moss SE, Klein R, Klein BE. The Prevalence and Incidence of Lower Extremity Amputation in a Diabetic Population. Arch Intern Med. 1992;152(3):610-6. PubMed PMID: 1546925.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The prevalence and incidence of lower extremity amputation in a diabetic population. AU - Moss,S E, AU - Klein,R, AU - Klein,B E, PY - 1992/3/1/pubmed PY - 1992/3/1/medline PY - 1992/3/1/entrez SP - 610 EP - 6 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 152 IS - 3 N2 - OBJECTIVE: To describe the incidence of lower extremity amputations and sores or ulcers and investigate risk factors for these complications. DESIGN: Cohort. SETTING: Primary care. PARTICIPANTS: Population-based sample (N = 1210) of younger-onset diabetic persons (diagnosed before age 30 years and taking insulin) and a stratified random sample (N = 1780) of older-onset diabetic persons (diagnosed after age 30 years). Baseline and 4-year follow-up examinations were completed by 996 and 891 younger-onset persons, respectively, and by 1370 and 987 older-onset persons, respectively. MAIN OUTCOME MEASURES: Amputations and sores or ulcers of the lower extremities. RESULTS: Four-year incidence of amputations was 2.2% in both groups. Incidence of sores or ulcers was 9.5% in younger-onset and 10.5% in older-onset persons. In younger-onset persons, significant risk factors for amputation with odds ratios (and 95% confidence intervals) include age, 2.0 for 10 years (1.2 to 3.1), history of sores or ulcers, 10.5 (3.7 to 29.8), diastolic blood pressure, 2.1 for 10 mm Hg (1.3 to 3.5), and pack-years smoked, 1.3 for 10 years (1.0 to 1.6). Risk factors for sores or ulcers include glycosylated hemoglobin, 1.6 for 2% (1.3 to 2.0), retinopathy, 1.3 for two steps (1.1 to 1.6), and current smoking, 2.3 (1.0 to 5.6). In older-onset persons, risk factors for amputation are history of sores or ulcers, 4.6 (1.7 to 12.2), proteinuria, 4.3 (1.6 to 11.5), glycosylated hemoglobin, 1.5 for 2% (1.0 to 2.2), sex, 2.8 for males (1.0 to 7.5), and duration of diabetes, 1.8 for 10 years (1.0 to 3.2). For sores or ulcers, risk factors are glycosylated hemoglobin, 1.6 for 2% (1.3 to 2.0), duration, 1.5 for 10 years (1.0 to 2.1), proteinuria, 2.2 (1.1 to 4.3), and diastolic blood pressure, 0.8 for 10 mm Hg (0.6 to 1.0). CONCLUSIONS: Several factors offer potential for modification for the prevention of amputations but require further study. These include blood pressure, glycosylated hemoglobin, and smoking. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/1546925/The_prevalence_and_incidence_of_lower_extremity_amputation_in_a_diabetic_population_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/vol/152/pg/610 DB - PRIME DP - Unbound Medicine ER -