title: Medical strategies to reduce amputation in patients with type 2 diabetes.
abstract: Lower extremity amputation is a common and disabling complication of Type 2 diabetes. Whilst the introduction of specialist multidisciplinary teams has led to a reduction in the incidence of lower extremity amputation in some centres, the overall prevalence of diabetes-related amputation has actually increased in recent decades. The aetiology of diabetes-related amputation is complex, with neuropathy, macrovascular and microvascular disease contributing significantly. Ulceration, previous amputation, increasing diabetes duration and poor long-term control of glycaemia and lipids are important risk factors for amputation in populations with diabetes. Major randomized intervention trials of blood glucose-lowering or anti-hypertensive therapies in populations with diabetes have shown limited reductions in neuropathy and/or macrovascular disease, and no benefit on amputation rates. In contrast, a recent analysis from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study showed a significantly reduced rate of minor, but not major amputations in patients with Type 2 diabetes treated with fenofibrate. Mechanistic studies are clearly needed to understand the basis of this benefit.
authors: Division of Cardiovascular Medicine, University of Manchester, Manchester, UK. rayaz.a.malik@man.ac.uk
authors: R A
authors: RA
authors: Malik
authors: S
authors: S
authors: Tesfaye
authors: D
authors: D
authors: Ziegler
mesh_terms: D000671:Amputation, Surgical / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D003925:Diabetic Angiopathies / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D017719:Diabetic Foot / Q000453:epidemiology / Q000517:prevention & control / Q000601:surgery / Q000628:therapy; D003929:Diabetic Neuropathies / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D004359:Drug Therapy, Combination; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents