Identifying Cause for Advancement to Amputation in Patients With Diabetes: The Role of Medical Care and Patient Compliance

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Identifying Cause for Advancement to Amputation in Patients With Diabetes: The Role of Medical Care and Patient Compliance
Posted 04/13/2005
Taffney Nash; James W. Bellew, EdD, PT; Marshall Cunningham, MD; Joseph McCulloch, PhD, PT
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Abstract
Background: Much is written regarding risk factors precipitating amputation in patients with diabetes. Two such factors are neuropathy and peripheral vascular disease (PVD). However, many patients with diabetes and these risk factors do not succumb to amputation. Factors that differentiate patients proceeding to amputation and those not, despite having the same risk factors, are unclear. Therefore, this investigation examined the quality of medical care and patient compliance in patients with diabetes and neuropathy and/or PVD.

Methods: Retrospective exploratory data analyses of 50 patients with diabetes and neuropathy and/or PVD who succumbed to amputation and 30 patients with diabetes and the same risk factors but did not advance to amputation were analyzed. Two variables, Medical Care and Patient Compliance, were created and operationally defined using current guidelines for management of patients with diabetes.

Results: In patients with diabetes that succumbed to amputation, Medical Care was poor in 92%, good in 0%, and average in 8%. Furthermore, Patient Compliance was poor in 79% and good in only 21%. In contrast, in patients that did not progress to amputation, Medical Care was rated poor in only 7%, good in 28%, and average in 65%, while Patient Compliance was rated poor in only 32% and good in 68%.

Conclusion: Medical Care below standard of care for patients with diabetes and poor Patient Compliance are significant predisposing factors for amputation in patients with diabetes. These data suggest that more comprehensive medical care and patient involvement may attenuate the risk of amputation in patients with diabetes.

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