Introduction and Objective: While the causes of lower-extremity amputation (LEA) are well-studied, the role of incident diabetic foot ulcer (DFU) has not been prospectively assessed. We evaluated the independent impact of DFU, alongside other factors, on LEA risk in a cohort of Veterans with diabetes at a single Department of Veterans Affairs clinic.Methods: A total of 1,458 male veterans with 2,893 lower limbs without DFU were followed between 1990 and 2002 (mean follow-up: 4.9 years). Risk factors were assessed using a flexible parametric survival model based on data from interviews (demographics, diabetes characteristics), physical exams (blood pressure, weight, Charcot deformity, visual acuity), and blood (albumin, HbA1c, eGFR) and neurovascular tests (10-g monofilament, TcPO2, ABI).Results: During follow-up, 227 DFUs (7.8%) and 72 LEAs (2.5%) occurred. Predictors of LEA (p < 0.05) in the final model adjusted for time-updated measurements (HR, 95% CI) included age ≥70 years [0.29, 0.08-0.97], prior amputation [2.31, 1.13-4.74], lower eGFR [1.16, 1.02-1.32], systolic BP [1.40, 1.11-1.78], ABI ≤0.5 [3.94, 2.03-7.62], and incident DFU [10.44, 6.01-18.15].Conclusion: In this prospective study, incident DFU emerged as having a substantial independent power in predicting LEA among other person- and limb-specific risk factors. Preventing DFU occurrence is critical to reducing the burden of LEA.
I.S. Al-Busaidi: None. A.D. Seelig: None. E.J. Boyko: None.
U.S. Department of Veterans Affairs Rehabilitation Research and Development Program.
Source link
Leave a Reply