Login Register Cart 0
Generic placeholder image

Current Vascular Pharmacology

Editor-in-Chief

ISSN (Print): 1570-1611
ISSN (Online): 1875-6212

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
General Research Article

The Neuro-Vascular Consequence of Diabetes: Foot Amputation and Evaluation of its Risk Factors and Health-Related Economic Impact

Author(s): Iftikhar Haider Naqvi*, Abu Talib, Sajjad Haider Naqvi, Lubabah Yasin and Nayema Zehra Rizvi

Volume 19, Issue 1, 2021

Published on: 20 March, 2020

Page: [102 - 109] Pages: 8

DOI: 10.2174/1570161118666200320112401

Price: $65

Open Access Journals Promotions 2
conference banner
Abstract

Background: The rising prevalence of type 2 diabetes mellitus (T2DM) with the huge burden of diabetic foot amputation is a challenge to the health economy of Pakistan and other countries. Identification of various risk factors for amputation, along with its financial burden, is needed to address this problem.

Objectives: This study aimed to determine the financial burden and risk factors associated with T2DMrelated foot amputation.

Methods: Retrospective hospital-based study from January 2017 to December 2018. Patients with T2DM with and without amputation were enrolled. The direct medical costs of amputation along with various risk factors, were determined. Risk factors were evaluated by logistic regression analysis.

Results: A total of 1460 patients with T2DM were included; 484 (33%) patients had an amputation. The mean total cost of below knee, fingers and toe amputation was 886.63±23.91, 263.35 ±19.58 and 166.68 ± 8.47 US$, respectively. This difference among groups was significant (p<0.0001). Male gender (odds ratio, OR: 1.29, 1.01-1.63, p=0.037), peripheral artery disease (OR: 1.93, 1.52-2.46, p=0.000), peripheral neuropathy (OR: 1.31, 1.40-1.63, p=0.000), prior diabetic foot ulcer (OR: 2.02, 1.56- 2.56, p=0.000) and raised glycated haemoglobin (HbA1c) (OR: 3.50, 2.75-4.4, p=0.000) were risk factors for amputation.

Conclusion: The health-related financial impact of amputations is high. Peripheral artery disease, peripheral neuropathy, prior diabetic foot ulcer and raised HbA1c were risk factors for amputation.

Keywords: Amputation, diabetic foot, health economics, glycated haemoglobin, peripheral artery disease, diabetic neuropathy.

« Previous Next »
Graphical Abstract

[1]
World Health Organization (WHO) Diabetes mellitus 2017. Available from . http://www.who.int/mediacentre/factsheets/fs138/en/ (Accessed on Aug 15, 2017).
[2]
Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil 2008; 89(3): 422-9.
[http://dx.doi.org/10.1016/j.apmr.2007.11.005] [PMID: 18295618]
[3]
Hoffstad O, Mitra N, Walsh J, Margolis DJ. Diabetes, lower-extremity amputation, and death. Diabetes Care 2015; 38(10): 1852-7.
[http://dx.doi.org/10.2337/dc15-0536] [PMID: 26203063]
[4]
Tiwari S, Pratyush DD, Dwivedi A, Gupta SK, Rai M, Singh SK. Microbiological and clinical characteristics of diabetic foot infections in northern India. J Infect Dev Ctries 2012; 6(4): 329-32.
[http://dx.doi.org/10.3855/jidc.1827] [PMID: 22505442]
[5]
National Amputee Statistical Database annual report 2004/2005. Available from:. http://www.limbless-statistics.org (Accessed on May 04, 2019)
[6]
Peter-Riesch B. The diabetic foot: the never-ending challenge. Endocr Dev 2016; 31: 108-34.
[http://dx.doi.org/10.1159/000439409] [PMID: 26824745]
[7]
Wu SC, Driver VR, Wrobel JS, Armstrong DG. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag 2007; 3(1): 65-76.
[PMID: 17583176]
[8]
Neidrauer M, Zubkov L, Weingarten MS, Pourrezaei K, Papazoglou ES. Near infrared wound monitor helps clinical assessment of diabetic foot ulcers. J Diabetes Sci Technol 2010; 4(4): 792-8.
[http://dx.doi.org/10.1177/193229681000400404] [PMID: 20663439]
[9]
Wong KL, Nather A, Liang S, Chang Z, Wong TT, Lim CT. Clinical outcomes of below knee amputations in diabetic foot patients. Ann Acad Med Singapore 2013; 42(8): 388-94.
[PMID: 24045374]
[10]
Ali SM, Basit A, Sheikh T, Mumtaz S, Hydrie MZ. Diabetic foot ulcer--a prospective study. J Pak Med Assoc 2001; 51(2): 78-81.
[PMID: 11321877]
[11]
Ince P, Abbas ZG, Lutale JK, et al. Use of the SINBAD classification system and score in comparing outcome of foot ulcer management on three continents. Diabetes Care 2008; 31(5): 964-7.
[http://dx.doi.org/10.2337/dc07-2367] [PMID: 18299441]
[12]
Weledji EP, Fokam P. Treatment of the diabetic foot - to amputate or not? BMC Surg 2014; 14(1): 83.
[http://dx.doi.org/10.1186/1471-2482-14-83] [PMID: 25344293]
[13]
Wu S, Armstrong DG, Lavery LA, Harkless LB. Clinical examination of the diabetic foot and the identification of the at-risk patient. Diabetic Foot 2006; pp. 201-26.
[http://dx.doi.org/10.1007/978-1-59745-075-1_11]
[14]
Oksuz E, Malhan S, Sonmez B, Numanoglu TR. Cost of illness among patients with diabetic foot ulcer in Turkey. World J Diabetes 2016; 7(18): 462-9.
[http://dx.doi.org/10.4239/wjd.v7.i18.462] [PMID: 27795820]
[15]
Baker K. Keeping people’s feet perfect. Diabetes Voice 2005; 50: 3.
[16]
Economic Indicators; 2019.Pakistan Finance Division Available from:. http://finance.gov.pk/survey/chapters_19/Economic%20Indicators%201819 (Accessed on 29 Nov 2019)
[17]
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2014; 37(1): 81-90.
[PMID: 23959568]
[18]
Wagner FW Jr. The diabetic foot. Orthopedics 1987; 10(1): 163-72.
[http://dx.doi.org/10.3928/0147-7447-19870101-28] [PMID: 3809012]
[19]
Yesil S, Akinci B, Yener S, et al. Predictors of amputation in diabetics with foot ulcer: single center experience in a large Turkish cohort. Hormones (Athens) 2009; 8(4): 286-95.
[http://dx.doi.org/10.14310/horm.2002.1245] [PMID: 20045802]
[20]
Ashraf MN. Khalil-ur-Rehman, Malik KI, Iqbal GS. Epidemiology and outcome in patients of diabetic foot. J Ayub Med Coll 2011; 23(1): 122-4.
[21]
Ghosh P, Valia R. Burden of diabetic foot ulcers in India: evidence landscape from published literature. Value Health 2017; 20(9): A485.
[http://dx.doi.org/10.1016/j.jval.2017.08.489]
[22]
Nanwani B, Shankar P, Kumar R, Shaukat F. Risk factors of diabetic foot amputation in Pakistani type ii diabetes individuals. Cureus 2019; 11(6)e4795
[http://dx.doi.org/10.7759/cureus.4795] [PMID: 31396465]
[23]
Musa IR, Ahmed MON, Sabir EI, et al. Factors associated with amputation among patients with diabetic foot ulcers in a Saudi population. BMC Res Notes 2018; 11(1): 260.
[http://dx.doi.org/10.1186/s13104-018-3372-z] [PMID: 29703224]
[24]
Liu M, Zhang W, Yan Z, Yuan X. Smoking increases the risk of diabetic foot amputation: A meta-analysis. Exp Ther Med 2018; 15(2): 1680-5.
[PMID: 29434753]
[25]
Al-Thani H, Sathian B, El-Menyar A. Assessment of healthcare costs of amputation and prosthesis for upper and lower extremities in a Qa-tari healthcare institution: a retrospective cohort study. BMJ Open 2019; 9(1)e024963
[http://dx.doi.org/10.1136/bmjopen-2018-024963] [PMID: 30782746]
[26]
Ali SM, Fareed A, Humail SM, et al. The personal cost of diabetic foot disease in the developing world--a study from Pakistan. Diabet Med 2008; 25(10): 1231-3.
[http://dx.doi.org/10.1111/j.1464-5491.2008.02529.x] [PMID: 19046203]
[27]
Raghav A, Khan ZA, Labala RK, Ahmad J, Noor S, Mishra BK. Financial burden of diabetic foot ulcers to world: a progressive topic to discuss always. Ther Adv Endocrinol Metab 2018; 9(1): 29-31.
[http://dx.doi.org/10.1177/2042018817744513] [PMID: 29344337]
[28]
Apelqvist J, Ragnarson-Tennvall G, Persson U, Larsson J. Diabetic foot ulcers in a multidisciplinary setting. An economic analysis of primary healing and healing with amputation. J Intern Med 1994; 235(5): 463-71.
[http://dx.doi.org/10.1111/j.1365-2796.1994.tb01104.x] [PMID: 8182403]
[29]
Pemayun TG, Naibaho RM, Novitasari D, Amin N, Minuljo TT. Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case-control study. Diabet Foot Ankle 2015; 6(1): 29629.
[http://dx.doi.org/10.3402/dfa.v6.29629] [PMID: 26651032]
[30]
Sen P, Demirdal T, Emir B. Meta-analysis of risk factors for amputation in diabetic foot infections. Diabetes Metab Res Rev 2019; 35(7)e3165
[http://dx.doi.org/10.1002/dmrr.3165] [PMID: 30953392]
[31]
Quilici MT, Del Fiol Fde S, Vieira AE, Toledo MI. Risk factors for foot amputation in patients hospitalized for diabetic foot infection. J Diabetes Res 2016; 20168931508
[PMID: 26998493]
[32]
Ugwu E, Adeleye O, Gezawa I, Okpe I, Enamino M, Ezeani I. Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study. J Foot Ankle Res 2019; 12(1): 34.
[http://dx.doi.org/10.1186/s13047-019-0345-y] [PMID: 31223342]
[33]
Lind M, Pivodic A, Svensson AM, Ólafsdóttir AF, Wedel H, Ludvigsson J. HbA1c level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes: Swedish population based cohort study. BMJ 2019; 366: l4894.
[http://dx.doi.org/10.1136/bmj.l4894] [PMID: 31462492]
[34]
Shatnawi NJ, Al-Zoubi NA, Hawamdeh HM, Khader YS, Garaibeh K, Heis HA. Predictors of major lower limb amputation in type 2 diabetic patients referred for hospital care with diabetic foot syndrome. Diabetes Metab Syndr Obes 2018; 11: 313-9.
[http://dx.doi.org/10.2147/DMSO.S165967] [PMID: 29950877]

Rights & Permissions Print Cite
Article Metrics
48
Wayfinder Image
Open Access Journals Promotions
World Prematurity Day
© 2024 Bentham Science Publishers | Privacy Policy