title: Diabetes-related lower-extremity amputation incidence and risk factors: a prospective seven-year study in Costa Rica.
abstract: OBJECTIVE
  To analyze the incidence and determinants of lower-extremity amputation (LEA) in people with diabetes in a low-income community in Costa Rica.
  
  
  METHODS
  Data on LEA incidence were collected during a seven-year follow-up (2001-2007) in a diabetes patient cohort (n = 572). Risk factors were analyzed using the Cox proportional hazards regression model and baseline variables from the year 2000 (socio- demographic characteristics, comorbidity, metabolic control, treatment, and chronic microvascular complications).
  
  
  RESULTS
  LEA incidence was 6.02 per 1 000 person-years (8.65 in men and 4.50 in women). Known risk factors (sex, years of diabetes, elevated glycated hemoglobin [HbA1c], retinopathy, insulin therapy, and prior amputation) were highly significant.
  
  
  CONCLUSIONS
  Those most likely to undergo LEA among Costa Rican diabetic patients were men with 10 or more years of diabetes and average HbA1c > 8% who used insulin and had diabetic retinopathy. Patients on insulin therapy were at greatest risk, especially those with a previous amputation. Diabetic patients with the above-mentioned profile should be considered to be at very high risk of LEA and followed closely by the health care system.
authors.affiliation: Instituto de Investigaciones en Salud, Universidad de Costa Rica, San José, Costa Rica. adriana.lacle@ucr.ac.cr
authors.forename: Adriana
authors.initials: A
authors.lastname: Laclé
authors.forename: Luis F
authors.initials: LF
authors.lastname: Valero-Juan
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D015897:Comorbidity; D003364:Costa Rica / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000601:surgery*; D017719:Diabetic Foot / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use; D007511:Ischemia / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D007866:Leg / Q000098:blood supply / Q000601:surgery*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000453:epidemiology; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin