title: Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients.
abstract: Treatment strategies for foot at risk and diabetic foot are mainly preventive. Studies describing demographic data, clinical and impacting factors continue to be, however, scarce. Our objective was to determine the epidemiological presentation of diabetic foot and understand whether there were easily assessable variables capable of predicting the development of diabetic foot. This was a retrospective study of 496 patients with established foot at risk or diabetic foot, who were evaluated based on age, gender, type and duration of diabetes, foot at risk classification, and the presence of deformities, ulceration, and amputation. The presence of deformities, ulceration, and amputation was recorded in 45.9, 25.3, and 12.9 % of patients, respectively. As for diabetic foot classification, the great majority of our cohort had diabetic neuropathy (92.9 %). Approximately 30 % had neuro-ischemic disease and only 7.1 % had ischemic disease alone. Sixty-two percent of patients presented neuropathy with no signs of arteriopathy. Foot classification was as a significant predictor for the presence of ulcer (p = 0.009; OR = 3.2; 95 % CI = 1.18-7.3). Only male gender was a significant predictor for ulceration (p < 0.001). Predictors of amputation were male gender (p < 0.001; OR = 3.44 95 % CI = 1.81-6.56) and neuro-ischemic diabetic foot (p < 0.049; OR = 4.6; 95 % CI = 1.01-20.9). The predictors for diabetic foot were male gender and the presence of neuropathy. The combination of neuropathy and peripheral vascular disease adds significantly to the risk for amputation among patients with the diabetic foot syndrome. Men, presenting combined risk factors, should be a group receiving special attention and in the foot clinic, due to their potentially worse evolution.
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil.
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Moura Neto
authors.forename: Denise Engelbrecht
authors.initials: DE
authors.lastname: Zantut-Wittmann
authors.forename: Tulio Diniz
authors.initials: TD
authors.lastname: Fernandes
authors.forename: Marcia
authors.initials: M
authors.lastname: Nery
authors.forename: Maria Candida Ribeiro
authors.initials: MC
authors.lastname: Parisi
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D017719:Diabetic Foot / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005531:Foot Deformities, Acquired / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D018409:Foot Injuries / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors