The Problem of Amputations Among People With Diabetes

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The Problem of Amputations Among People With Diabetes
2006
American Diabetes Association

Risk factors for major limb amputations in diabetic foot gangrene patients, by S. Miyajima and colleagues. Diab Res Clin Prac 71:272-279, 2006.

What is the problem and what is known about it so far?

Diabetes can harm blood vessels to the point where people can get ulcers (sores) on their feet. Left alone, foot ulcers and poor circulation can lead to a condition called gangrene. Amputating (surgically cutting off) the affected foot or leg is often the result.
Why did the researchers do this particular study?

Doctors wanted to know which patients with diabetes are more likely to need amputations for gangrene.
Who was studied?

The study included 210 people who had been treated for diabetes foot ulcers at one hospital in Japan over a nine-year period.
How was the study done?

Participants had a physical exam and blood drawn for lab tests. They were followed for an average of 600 days
What did the researchers find?

By the end of the follow-up period, 18 patients had surgery to improve blood flow to the affected limb. Thirteen patients had skin grafts to cover ulcers, and 110 patients ended up needing amputation.

Amputation was more likely in participants who had a blood vessel disease known as arteriosclerosis obliterans (which results in closing of the blood vessels), had high long-term blood glucose levels, or needed dialysis (a medical procedure to remove wastes from the blood after the kidneys have failed).
What were the limitations of the study?

All the participants were Japanese and from one hospital, which could reflect on differences in how people are treated by the health care team. The results from this group of people may not apply to other people.
What are the implications of the study?

Understanding what makes amputation more likely can help doctors identify patients who need closer attention. Early detection and treatment may reduce the number of people with diabetes who need to have limb amputation.