Thailand diabetes registry project: prevalence and risk factors associated with lower extremity amputation in Thai diabetics.
OBJECTIVE
To determine the prevalence and risk factors associated with lower extremity amputation (LEA) in Thai diabetics.


METHODS
A cross-sectional, multicenter hospital-based diabetes registry was carried out from April to December 2003. Baseline characteristics and risk factors were analysed from 9419 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 ofLEAs 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).


CONCLUSIONS
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.
Krittiyawong
Sirinate
S
Theptarin General Hospital, 3850 Rama 4 Rd, Bangkok 10110, Thailand. Sirinate@Theptarin.com
Ngarmukos
Chardpraom
C
Benjasuratwong
Yupin
Y
Rawdaree
Petch
P
Leelawatana
Rattana
R
Kosachunhanun
Natapong
N
Plengvidhya
Nattachet
N
Deerochanawong
Chaicharn
C
Suwanwalaikorn
Sompongse
S
Pratipanawatr
Thongchai
T
Chetthakul
Thanya
T
Mongkolsomlit
Sirima
S
Bunnag
Pongamorn
P
D000671:Amputation, Surgical; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016730:Program Development; D015397:Program Evaluation; D012042:Registries; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology