Frequency of lower extremity amputation in diabetics with reference to glycemic control and Wagner's grades.
OBJECTIVE
To determine the frequency of minor and major amputations in diabetic patients at different Wagner s grades of severity and to correlate it with the glycaemic control.


METHODS
Cross-sectional analytical study.


METHODS
Department of Orthopedic Surgery, Jinnah Postgraduate Medical Centre, Karachi, over a period of 3 years from August 1999 to August 2002.


METHODS
The study included 60 patients of diabetic foot disease, who were distributed in to six grades of severity according to the Wagner s method. Glycaemic control was determined by baseline fasting and random blood sugar and HbA1c levels. Patients were treated accordingly and followed-up. Frequencies of minor and major amputations were found and these were correlated with the glycemic control of the patients.


RESULTS
There was no patient in grade-0, 6 (10%) patients in grade-I, 13 (21.6%) in grade-II, 14 (23.3%) in grade-III, 18 (30%) in grade-IV and 9 (15%) patients in grade-V respectively. Thirty-seven (61.6%) patients were male. The mean age of the patients was 50.88 +/- 11.06 years. In 40 (66.7%) patients, the duration of diabetes was 8 years or longer. Fifty six (93.3%) were having NIDDM and 35 (58.3%) were smokers. Staphylococcus aureus was the most common pathogen isolated from the wound. Only 1 (16.6%) patient in grade I underwent minor amputation, while 3 (23.7%), 8 (57.14%) and 8 (44.44%) underwent minor amputation in grades II, III and IV respectively. Three (21.42%), 10 (55.55%) and all 9 (100%) underwent major amputation in grade III, IV and V respectively. Below-the-knee amputation was the most commonly performed procedure. Overall frequency of minor and major amputation were 20 (33.3%) and 22 (36.3%) respectively. Patients with poor glycaemic control had higher percentage of minor and major amputation (p-value = 0.001).


CONCLUSIONS
The frequency of minor and major amputation increases with the higher grades of diabetic foot. Poor glycaemic control is a significant risk factor for amputation in diabetic foot patients.
Imran
Shaikh
S
Department of Orthopaedic Surgery, JPMC, Karachi.
Ali
Rajab
R
Mahboob
Ghulam
G
D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D001786:Blood Glucose / Q000378:metabolism*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000601:surgery*; D017719:Diabetic Foot / Q000097:blood / Q000601:surgery*; D005260:Female; D005528:Foot / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
D001786:Blood Glucose