title: Risk factors predicting lower extremity amputations in patients with NIDDM.
abstract: OBJECTIVE
  To examine the predictors of lower extremity amputation in patients with NIDDM.
  
  
  METHODS
  At baseline, risk factors for amputation were determined in 1,044 NIDDM patients (571 men, 473 women) aged 45 to 64 years. These patients were followed up to 7 years with respect to amputation.
  
  
  RESULTS
  The incidence of amputation was 5.6% in men and 5.3% in women. High fasting plasma glucose at baseline examination and the duration of diabetes were associated with a twofold risk for amputation. Similarly, glycemic control measured at baseline by HbA1 was an important predictor of amputation. There was a dose-response relationship between plasma glucose or HbA1 and the risk for amputation. The effect of hyperglycemia on the risk of amputation was seen clearly even after the adjustment for other cardiovascular risk factors. Signs of peripheral neuropathy and bilateral absence of Achilles tendon reflexes and vibration sense were important predictors for amputation. Furthermore, absent peripheral artery pulses and femoral artery bruit on auscultation predicted amputation.
  
  
  CONCLUSIONS
  Our 7-year follow-up study gives strong evidence that poor glycemic control is an important predictor of amputation in patients with NIDDM in addition to clinically detectable peripheral arterial disease and peripheral neuropathy.
authors.affiliation: Department of Medicine, Kuopio University Hospital, Finland.
authors.forename: S
authors.initials: S
authors.lastname: Lehto
authors.forename: T
authors.initials: T
authors.lastname: Rönnemaa
authors.forename: K
authors.initials: K
authors.lastname: Pyörälä
authors.forename: M
authors.initials: M
authors.lastname: Laakso
mesh_terms: D000125:Achilles Tendon; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology; D003925:Diabetic Angiopathies; D003929:Diabetic Neuropathies; D003930:Diabetic Retinopathy; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia; D007866:Leg; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012018:Reflex; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking; D014280:Triglycerides / Q000097:blood
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D002784:Cholesterol; D006442:Glycated Hemoglobin; D014280:Triglycerides