title: Baseline characteristics and risk factors for ulcer, amputation and severe neuropathy in diabetic foot at risk: the BRAZUPA study.
abstract: BACKGROUND
  Studies on diabetic foot and its complications involving a significant and representative sample of patients in South American countries are scarce. The main objective of this study was to acquire clinical and epidemiological data on a large cohort of diabetic patients from 19 centers from Brazil and focus on factors that could be associated with the risk of ulcer and amputation.
  
  
  METHODS
  This study presents cross sectional, baseline results of the BRAZUPA Study. A total of 1455 patients were included. Parameters recorded included age, gender, ethnicity, diabetes and comorbidity-related records, previous ulcer or amputation, clinical symptomatic score, foot classification and microvascular complications.
  
  
  RESULTS
  Patients with ulcer had longer disease duration (17.2 ± 9.9 vs. 13.2 ± 9.4 years; p < 0.001), and poorer glycemic control (HbA1c 9.23 ± 2.03 vs. 8.35 ± 1.99; p < 0.001). Independent risk factors for ulcer were male gender (OR 1.71; 95 % CI 1.2-3.7), smoking (OR 1.78; 95 % CI 1.09-2.89), neuroischemic foot (OR 20.34; 95 % CI 9.31-44.38), region of origin (higher risk for those from developed regions, OR 2.39; 95 % CI 1.47-3.87), presence of retinopathy (OR 1.68; 95 % CI 1.08-2.62) and absence of vibratory sensation (OR 7.95; 95 % CI 4.65-13.59). Risk factors for amputation were male gender (OR 2.12; 95 % CI 1.2-3.73), type 2 diabetes (OR 3.33; 95 % CI 1.01-11.1), foot at risk classification (higher risk for ischemic foot, OR 19.63; 95 % CI 3.43-112.5), hypertension (lower risk, OR 0.3; 95 % CI 0.14-0.63), region of origin (South/Southeast, OR 2.2; 95 % CI 1.1-4.42), previous history of ulcer (OR 9.66; 95 % CI 4.67-19.98) and altered vibratory sensation (OR 3.46; 95 % CI 1.64-7.33). There was no association between either outcome and ethnicity.
  
  
  CONCLUSIONS
  Ulcer and amputation rates were high. Age at presentation was low and patients with ulcer presented a higher prevalence of neuropathy compared to ischemic foot at risk. Ischemic disease was more associated with amputations. Ethnical differences were not of great importance in a miscegenated population.
authors.affiliation: Faculty of Medical Sciences, State University of Campinas, Campinas, SP 13083-887 Brazil ; Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Maria Candida R
authors.initials: MC
authors.lastname: Parisi
authors.affiliation: Faculty of Medical Sciences, State University of Campinas, Campinas, SP 13083-887 Brazil.
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Moura Neto
authors.affiliation: Faculty of Medical Sciences, State University of Campinas, Campinas, SP 13083-887 Brazil.
authors.forename: Fabio H
authors.initials: FH
authors.lastname: Menezes
authors.affiliation: Unity of Diabetes, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Marilia Brito
authors.initials: MB
authors.lastname: Gomes
authors.affiliation: Unity of Diabetes, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Rodrigo Martins
authors.initials: RM
authors.lastname: Teixeira
authors.affiliation: Department of Nutrology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: José Egídio Paulo
authors.initials: JE
authors.lastname: de Oliveira
authors.affiliation: Department of Nutrology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Joana Rodrigues Dantas
authors.initials: JR
authors.lastname: Pereira
authors.affiliation: Centre for Diabetes and Endocrinology in the State of Bahia (CEDEBA), Salvador, Brazil.
authors.forename: Reine Marie Chaves
authors.initials: RM
authors.lastname: Fonseca
authors.affiliation: Centre for Diabetes and Endocrinology in the State of Bahia (CEDEBA), Salvador, Brazil.
authors.forename: Lorena Barreto Arruda
authors.initials: LB
authors.lastname: Guedes
authors.affiliation: Centro Integrado de diabetes e Hipertensão do Ceará, Fortaleza, Brazil.
authors.forename: Adriana
authors.initials: A
authors.lastname: Costa E Forti
authors.affiliation: State University of Feira de Santana, Feira de Santana, Brazil.
authors.forename: Ana Mayra Andrade
authors.initials: AM
authors.lastname: de Oliveira
authors.affiliation: Federal University of Campina Grande, Campina Grande, Brazil.
authors.forename: Marta Barreto
authors.initials: MB
authors.lastname: de Medeiros Nóbrega
authors.affiliation: Federal University of Campina Grande, Campina Grande, Brazil.
authors.forename: Víctor Nóbrega Quintas
authors.initials: VN
authors.lastname: Colares
authors.affiliation: Hospital das Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil ; Santa Casa de Porto Alegre, Porto Alegre, RS Brazil.
authors.forename: Helena
authors.initials: H
authors.lastname: Schmid
authors.affiliation: Hospital das Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil ; Santa Casa de Porto Alegre, Porto Alegre, RS Brazil.
authors.forename: Otto Henrique
authors.initials: OH
authors.lastname: Nienov
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Marcia
authors.initials: M
authors.lastname: Nery
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Túlio Diniz
authors.initials: TD
authors.lastname: Fernandes
authors.affiliation: Hospital Regional de Taguatinga, Brasília, Brazil.
authors.forename: Hermelinda C
authors.initials: HC
authors.lastname: Pedrosa
authors.affiliation: Faculdade de Medicina, Federal University of Santa Catarina, Florianopolis, Brazil.
authors.forename: Cristina da S
authors.initials: Cda S
authors.lastname: Schreiber de Oliveira
authors.affiliation: Faculdade de Medicina, Federal University of Santa Catarina, Florianopolis, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Ronsoni
authors.affiliation: Federal University of Sergipe, São Cristóvão, Brazil.
authors.forename: Karla Freire
authors.initials: KF
authors.lastname: Rezende
authors.affiliation: Pontifícia Universidade Católica de Sorocaba, Sorocaba, Brazil.
authors.forename: Maria Teresa Verrone
authors.initials: MT
authors.lastname: Quilici
authors.affiliation: Pontifícia Universidade Católica de Sorocaba, Sorocaba, Brazil.
authors.forename: Alexandre Eduardo Franzin
authors.initials: AE
authors.lastname: Vieira
authors.affiliation: Division of Endocrinology, Hospital Agamenon Magalhães, Recife, Brazil.
authors.forename: Geisa Maria Campos
authors.initials: GM
authors.lastname: de Macedo
authors.affiliation: Faculdade de Medicina de Catanduva, Catanduva, Brazil.
authors.forename: Eliana Gabas
authors.initials: EG
authors.lastname: Stuchi-Perez
authors.affiliation: Faculdade de Medicina de Botucatu, UNESP, Botucatu, Brazil.
authors.forename: Kandir Genésio Innocenti
authors.initials: KG
authors.lastname: Dinhane
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Ribeirão Preto, Brazil.
authors.forename: Ana Emilia
authors.initials: AE
authors.lastname: Pace
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Ribeirão Preto, Brazil.
authors.forename: Maria Cristina Foss
authors.initials: MC
authors.lastname: de Freitas
authors.affiliation: Santa Casa de Belo Horizonte, Belo Horizonte, Brazil.
authors.forename: Maria Regina
authors.initials: MR
authors.lastname: Calsolari
authors.affiliation: Faculty of Medical Sciences, State University of Campinas, Campinas, SP 13083-887 Brazil.
authors.forename: Mario José Abdalla
authors.initials: MJ
authors.lastname: Saad
keywords: Amputation; Brazil; Diabetes; Risk factors for ulcer; Severe neuropathy