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Predictors of major lower limb amputation in type 2 diabetic patients referred for hospital care with diabetic foot syndrome

Authors Shatnawi NJ, Al-Zoubi NA, Hawamdeh HM, Khader YS, Gharaibeh K, Heis HA

Received 23 February 2018

Accepted for publication 27 April 2018

Published 22 June 2018 Volume 2018:11 Pages 313—319

DOI https://doi.org/10.2147/DMSO.S165967

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 4

Editor who approved publication: Professor Ming-Hui Zou


Nawaf J Shatnawi,1 Nabil A Al-Zoubi,1 Hassan M Hawamdeh,2 Yousef S Khader,3 Khaled Garaibeh,4 Hussein A Heis1

1Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Basic Medical Science, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan; 4Department of Orthopedic Surgery, Jordan University of Science and Technology, Irbid, Jordan

Purpose: This study was conducted to determine the risk factors of major lower extremity amputations in type 2 diabetic patients referred for hospital care with diabetic foot syndrome.
Patients and methods: This retrospective study involved 225 type 2 diabetic patients referred for management of diabetic foot syndrome at King Abdullah University Hospital in the period between January 2014 and December 2015. A structured customized diabetic foot data collection form with diabetic foot characteristics chart was used for documentation of relevant information, which checks for age, sex, body mass index, smoking, duration of diabetes, diabetic control therapy, associated hypertension, cardiac diseases, stroke, chronic renal impairment, renal replacement therapy (hem-dialysis), and history of diabetes-related complication in both feet prior to the study period. The predictors for major lower limb amputations were compared between groups using chi-square test, and binary logistic regression was used to determine the factors associated with major amputation.
Results: Twenty-seven limbs underwent major amputations with an overall rate of major amputation of 11.6%. The following predictors were found to be associated with the higher incidence of major lower limb amputations: duration of diabetes ≥15 years, HbA1c ≥8%, patients on insulin, with hypertension, cardiac diseases, chronic renal impairment, stroke, having gangrene, higher number of components, higher Wagner classification, and ischemia. However, the rate did not differ significantly between men and women.
Conclusion: Presentation with gangrenous tissue and poor glycemic control are the important risks and significant predictive factors for type 2 diabetes-related major lower limb amputations.

Keywords: diabetes mellitus, amputations, diabetic foot complication, gangrene

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