Incidence and Risk Factors for Amputations in Persons with Diabetes Mellitus: A Retrospective Cohort Study.

Mariana Alves Bandeira, Rosana Nascimento Macedo, José Luis Lázaro-Martinez, Yolanda Garcia Alvarez, Michele Neves Brajão Rocha, Vera Lucia Conceição de Gouveia Santos
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Abstract

The aim of this study was to identify and analyze the incidence rate of amputations and their risk factors in people with Diabetes Mellitus (DM) in two specialized outpatient clinics in Brazil. This is an epidemiological, retrospective cohort study using data collected from electronic health records of 281 adult diabetic patient types 1 or 2; attended in specialized outpatient service between 2015 and 2020. Statistical analyses were performed using the 2 sample t-test or Wilcoxon-Mann-Whitney test, for quantitative variables, and the Pearson's χ2 test or Fisher's exact test for categorical variables. The investigation of the risk factors for amputation was carried out through logistic regression. The study was approved by ethical committee. The sample mean age was 65.6 years (SD 13.05), predominating male gender n = 211 (75%), type 2 DM n = 223 (86.7%), with cardiovascular disease n = 143 (63.2%), and about 68.7% (n = 156) with peripheral arterial disease (PAD). Seventy-seven had lower limb amputation (LLA), with a rate incidence of 31.9% during five years. Logistic regression analysis showed the following associations with amputation: Diabetic peripheral neuropathy increased the rate of amputation by 3.6 times (OR = 3.631, 95% CI = 1.214-11.353; P = .022), and peripheral arterial disease increased by 10 times (OR = 10.631; 95% CI = 2.969-57.029; P = .001). The LLA in individuals with DM in two specialized outpatient services was higher compared to international literature; DPN and PAD were confirmed as risk factors for amputation, according to literature. This finding suggests that the study population faces an increased risk of amputation, highlighting the urgent need for targeted interventions and implementing robust preventive strategies to transform the current scenario and mitigate these severe outcomes. A comprehensive approach is essential to proactively address the underlying issues and reduce the prevalence and impact of amputations in Brazil.

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糖尿病患者截肢的发生率和风险因素:回顾性队列研究
本研究旨在确定和分析巴西两家专科门诊中糖尿病(DM)患者的截肢发生率及其风险因素。这是一项流行病学回顾性队列研究,使用的数据收集自 2015 年至 2020 年期间在专科门诊就诊的 281 名 1 型或 2 型成年糖尿病患者的电子健康记录。定量变量采用双样本t检验或Wilcoxon-Mann-Whitney检验,分类变量采用Pearson's χ2检验或Fisher's精确检验进行统计分析。截肢风险因素的调查通过逻辑回归进行。该研究获得了伦理委员会的批准。样本平均年龄为 65.6 岁(SD 13.05),男性居多,n = 211(75%),2 型糖尿病患者 n = 223(86.7%),心血管疾病患者 n = 143(63.2%),外周动脉疾病患者约占 68.7%(n = 156)。有 77 人进行了下肢截肢(LLA),五年内的发病率为 31.9%。逻辑回归分析表明,截肢与以下因素有关:糖尿病周围神经病变使截肢率增加 3.6 倍(OR = 3.631,95% CI = 1.214-11.353;P = .022),周围动脉疾病使截肢率增加 10 倍(OR = 10.631;95% CI = 2.969-57.029;P = .001)。与国际文献相比,在两个专科门诊服务机构就诊的 DM 患者的 LLA 值更高;根据文献,DPN 和 PAD 被证实是截肢的风险因素。这一结果表明,研究人群面临截肢的风险增加,突出表明迫切需要采取有针对性的干预措施和实施强有力的预防策略,以改变目前的状况并减轻这些严重后果。要积极解决根本问题,降低巴西截肢的发生率和影响,必须采取综合方法。
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Incidence and Risk Factors for Amputations in Persons with Diabetes Mellitus: A Retrospective Cohort Study. Investigating Nonadherence in an Integrated Diabetic Limb Salvage Programme: Reasons, Associated Factors, and Impacts on Care Outcomes. Screening for Diabetic Peripheral Neuropathy: Subjective Versus Objective Measures. Comparative Effectiveness of Diode Laser Therapy and Topical Turmeric Extract Ointment in Promoting Healing of Wounds in a Murine Model. Heel Raises and Calf Stretches Exercises Versus Medication Only in Ischemic Intermittent Claudication: A Randomized Controlled Trial.
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