Endocrine Abstracts

Introduction

Diabetic foot is one of the most devastating of chronic complications of diabetes mellitus (DM) and is responsible for about 25% of hospitalizations. Worldwide, the diabetic foot represents the main cause of non-traumatic lower limb amputation.

Aim of the study

Identification of risk factors for foot amputation among in patients hospitalized for diabetic foot in a tertiary public hospital in Portugal.

Material and methods

Retrospective observational study of data collected from April 2017 to April 2020.

Results

There were 279 admissions involving 233 patients;161(69%) were males. Mean age was 68 ± 11.5 years and 219 (94%)] presented type 2 DM. The mean diabetes duration was 18.4 ± 10.5 years. Patients were divided into two groups: Group 1 (n = 140) patients not submitted to amputation; Group 2 (n = 93) patients submitted to amputation. There was no statistical difference between groups in terms of age (68.4 ± 11.6 vs. 67.5 ± 11.4 years), mean DM duration (18.1 ± 9.8 vs 18.8 ± 10.5 years), history of previous foot amputation (21.7% vs 30.1%), documentation of microvascular complications [retinopathy (50.4% vs 46.8%), neuropathy (75.8% vs 74.4%) and nephropathy (47% vs 52.2%)], smoking (26% vs 28.7%), high blood pression (84% vs 85%) and neuroischemic foot lesions (71.7% vs 78.5%). However, Group 2 presented higher HbA1c (8.1% vs 9.4%; P = 0.03), higher prevalence of osteomyelitis (28% vs 47%, P = 0.02) and higher prevalence of macrovascular complications: peripheral arterial disease (21.7% vs. 91.3%; P < 0.001) and ischemic heart disease (30% vs. 45%; P = 0.02). Regarding Grade 4 Wagner foot ulcer classification (localized gangrene) it was predominant in Group 2 (40% vs 10.8%; P = 0.01); all five patients with Grade 5 (extensive gangrene) were submitted to foot amputation. The global rate of mortality during hospitalization was 6.8% (n = 16) without significant differences between groups (5.8% vs 8.6%). The cause of death was sepsis in 7 cases, stroke in 2, sudden cardiac death in 3, acute myocardial infarction in 1, subdural hemorrhage in 1, and unknown cause in 2 cases.

Conclusions

Worse metabolic control and presence of peripheral arterial disease, ischemic heart disease or osteomyelitis as well as higher degrees in the classification of foot ulcers were risk factors for lower limb amputation among patients with DM. These results point to the need for an aggressive approach in this population, through preventive strategies, careful monitoring and management by multidisciplinary teams.