title: Epidemiology of type 2 diabetic foot problems and predictive factors for amputation in China.
abstract: To determine incidence and clinically relevant risk factors for diabetic amputation in a large cohort study of diabetic foot ulceration patients in China, we investigated a total of 669 diabetic foot ulceration patients, who were assessed at baseline for demographic information, medical and social history, peripheral neuropathy screening, periphery artery disease screening, assessment of nutritional status and diabetic control, physical examination including foot deformity in 15 Grade III-A hospitals. Of the 669 patients, 435 were male and 201 were female, with the mean age being 64.0 years. Of all patients, 110 had neuropathic ulcers, 122 had ischemic ulcers, 276 had neuroischemic ulcers, and 12 cases were unclassified. Wagner classification showed 61 cases were grade I, 216 cases grade II, 159 cases grade III, 137 cases grade IV, and 7 cases grade V. The overall amputation rate among diabetic foot patients was 19.03%, and major and minor amputation rates were 2.14% and 16.88%, respectively. By univariate analysis, statistically significant differences were found in smoking, rest pain, ulcer history, revascularization history, amputation history, gangrene, infection, Wagner grades, duration of diabetes, and postprandial blood glucose, aldehyde, total protein, globulin, albumin, white blood cell (WBC), hemoglobin, HbA1c, ulcer property, body mass index, as well as creatinine. Binary logistic regression model showed that increased WBC (odds ratio 1.25) and ulcer history (odds ratio 6.8) were associated with increased risks from diabetic foot ulcer to major amputation; increased duration of diabetes (odds ratio 1.004), WBC (odds ratio 1.102), infection (odds ratio 2.323), foot deformity (odds ratio 1.973), revascularization history (odds ratio 2.662), and decreased postprandial blood sugar (odds ratio 0.94) were associated with increased risks from diabetic foot ulcer to minor amputation. It is of great importance to give better management to diabetic patients at early stages. Following a diagnosis of DFU more intensive surveillance and aggressive care may improve outcome.
authors.affiliation: The Diabetic Center of PLA, The 306th Hospital of Chinese PLA, Beijing, China.
authors.forename: Yufeng
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Huaxi Hospital of Sichuan University, Chengdu, China.
authors.forename: Xingwu
authors.initials: X
authors.lastname: Ran
authors.affiliation: The Third Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Lijing
authors.initials: L
authors.lastname: Jia
authors.affiliation: Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Chuan
authors.initials: C
authors.lastname: Yang
authors.affiliation: Metabolic Diseases Hospital, Tianjin Medical University, Tianjin, China.
authors.forename: Penghua
authors.initials: P
authors.lastname: Wang
authors.affiliation: Nanjing Medical University Affiliated Nanjing Hospital, Nanjing, China.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Ma
authors.affiliation: Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Chen
authors.affiliation: Mudanjiang Diabetes Hospital, Mudanjiang, China.
authors.forename: Yanmei
authors.initials: Y
authors.lastname: Yu
authors.affiliation: East Hospital Affiliated to School of Medicine, Tongji University, Shanghai, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Feng
authors.affiliation: The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Lili
authors.initials: L
authors.lastname: Chen
authors.affiliation: Zhongda Hospital, Southeast University, Nanjing, China.
authors.forename: Han
authors.initials: H
authors.lastname: Yin
authors.affiliation: The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Zhifeng
authors.initials: Z
authors.lastname: Cheng
authors.affiliation: The Affiliated Hospital of Inner Mongolia Medical College, Hohhot, China.
authors.forename: Zhaoli
authors.initials: Z
authors.lastname: Yan
authors.affiliation: Heilongjiang Provincial Hospital, Harbin, China.
authors.forename: Yuzhi
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Shanghai Sixth People Hospital, Shanghai, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Liu
authors.affiliation: The Diabetic Center of PLA, The 306th Hospital of Chinese PLA, Beijing, China xzr1021@vip.sina.com.
authors.forename: Zhangrong
authors.initials: Z
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D002681:China / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D017719:Diabetic Foot / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
keywords: China; amputation; diabetic foot problem; epidemiology; risk factor