Risk factors for lower extremity amputation among patients with diabetes in Singapore.

Among other risk factors, renal disease and ethnicity have been associated with diabetic lower extremity amputation (LEA) in Western populations. However, little is known about risk factors for LEA among Asian patients. The objective was to assess the proportion of hospitalized patients with diabetes who have a LEA among all hospital patients with diabetes mellitus (DM) and to investigate risk factors for diabetic LEA (especially renal disease and ethnicity) using hospital discharge database. A retrospective study of hospital discharge database (2004-2009) was performed to identify patients with DM, LEA and renal disease using the International Statistical Classification of Diseases and Related Health Problems, Ninth Revision, Australian Modification codes. Of 44 917 hospitalized patients with DM during the 6 years, 7312 (16.3%) patients had renal disease, and 1457 (3.2%) patients had LEA. DM patients with renal disease had significant higher rates of LEA (7.1%) compared to DM patients without renal disease (2.5%, P < .001). The differences were present for foot (2.7% vs. 1.2%), ankle or leg (2.8% vs. 0.9%), and knee or above amputation (1.6% vs. 0.4%, all P<.001). Malays had the highest rate of diabetic LEA (5.1%), followed by Indians (3.0%), Chinese (3.0%), and others (2.3%, P < .001). In logistic regression analyses, renal disease and ethnicity were significant predictors of diabetic LEA (renal disease: odds ratio 3.2, 95% confidence interval 2.8-3.6; ethnicity: odds ratio, 1.6, Malays vs. Chinese, P < .001; 1.0, Indians vs. Chinese, P = .784) after adjustment for age, gender, and year of discharge. DM patients with renal disease and Malay ethnicity had higher rates of LEA in this Asian patient population. Malay patients with DM and diabetic patients with renal disease should be considered as high-risk groups for LEA and therefore screened and monitored systematically.

Yang Y ，Østbye T ，Tan SB ，Abdul Salam ZH ，Ong BC ，Yang KS ... -  《-》

The relationship between lower extremity amputation and body mass index.

Al Yafi M ，Nasif A ，Glosser LD ，Ren G ，Ahemd A ，Nazzal M ，Osman M ... -  《-》

Predictors of complication following lower extremity amputation in diabetic end-stage renal disease.

Patients with diabetic end-stage renal disease (ESRD) are at increased risk of lower extremity amputation (LEA) and postoperative complications compared to those without diabetic ESRD. This study sought to determine the factors that influence complications following LEA in patients with diabetic ESRD. A total of 41 patients with diabetic ESRD (total of 46 amputations) who underwent LEA were enrolled in this study. The electronic medical records were retrospectively reviewed to identify the predictors of postoperative complications. The outcomes were divided into three categories: no complications, minor complications (wounds requiring only local care or oral antibiotics), and major complications (requiring surgical intervention, further amputations, or inducing life-threatening morbidities and mortalities). Multivariate logistic regression analysis demonstrated that underlying sepsis (P = 0.007) was the only significant risk factor for major complications, with an odds ratio demonstrating an 8.16 times increased risk of requiring another surgery or mortality compared to those without sepsis. Preoperative sepsis is an independent risk factor for major complications after LEA in patients with diabetic ESRD. We advise particular caution when performing LEA in diabetic ESRD patients who are also septic. Early amputation, prior to the development of sepsis, is preferable.

Park YH ，Song JH ，Choi GW ，Kim HJ ... -  《-》

Diabetes-related lower extremity complications in a multi-ethnic Asian population: a 10 year observational study in Singapore.

Riandini T ，Pang D ，Toh MPHS ，Tan CS ，Liu DYK ，Choong AMTL ，Chandrasekar S ，Tai ES ，Tan KB ，Venkataraman K ... -  《-》

Effectiveness of Diabetes Foot Screening in Primary Care in Preventing Lower Extremity Amputations.

Ang GY ，Yap CW ，Saxena N 《-》