Thailand Diabetes Registry Project: Prevalence and risk factors associated with lower extremity amputation in Thai diabetics

Abstract

Objective: To determine the prevalence and risk factors associated with lower extremity amputation (LEA) in Thai diabetics. Material and Method: A cross-sectional, multicenter, hospital-based diabetes registry was carried out from April to December 2003. Baseline characteristics and risk factors were analysed from 9,419 diabetic patients. peripheral vascular disease (PVD) was defined as absent or diminished dorsalis pedis (DP) and posterior tibialis (PT) pulses to palpation in the same limb. LEA was defined as surgical removal of part of a lower extremity. Results: The prevalence of LEA was 1.5% (142). Mean diabetes duration was 10 years (SD = 7.6). Out of 556 patients with a history of foot ulcer, 123 (22.1%) underwent amputation. PVD was present in 370 patients. Most of LEAs were toe amputations (64.1%). Multiple logistic regression analysis of risk factors (adjusted OR, [95% confidence interval], p value) revealed a high risk of LEA in patients with a history of ulcer (59.2, [32.8-106.8], p < 0.001), peripheral vascular disease (5.3, [3.1-9.2], p < 0.001), diabetic retinopathy (2.2, [1.3-3.8], p = 0.004), and insulin injection (1.9, [1.1-3.2], p < 0.023). Conclusion: Patients at risk for LEA were those with a history of foot ulcer, absence of peripheral pulse, diabetic retinopathy and insulin injection. Preventive strategies should be considered in these groups of patients. Data should be interpreted with caution as the number of patients with amputation was few and information on neuropathy was not available.