Factors determining the risk of diabetes foot amputations--A retrospective analysis of a tertiary diabetes foot care service.
OBJECTIVE
To identify which factors predict the need for minor or major amputation in patients attending a multidisciplinary diabetic foot clinic (DFC).


METHODS
A retrospective analysis of patients who attended over a 27 month period were included. Patients had to have attended ≥3 consecutive consultant led clinic appointments within 6 months. Data was collected on HbA1c, clinic attendance, blood pressure, peripheral arterial disease (PAD), and co-morbidities. Patients were followed up for 1 year.


RESULTS
165 patients met the inclusion criteria. 121 were male. 33 patients had amputations. There was an association between poor glycaemic control at baseline and risk of amputation when adjusted for other factors, with those patients having HbA1c ≤58mmol/mol (7.5%) at less risk of amputation with an odds of 0.14 (0.04-0.53) of amputation(p=0.0036). Other statistically significant factors predictive of amputation were: missing clinic appointments (p=0.0079); a high Charlson index (p=0.03314); hypertension (p=0.0216). No previous revascularisation was protective against amputation (p=0.0035). However PAD was not seen to be statistically significant, although our results indicated a lower risk of amputation with no PAD. Overall, 34.9% (n=58) of patients had good glycaemic control (HbA1c <58mmol/mol, [7.5%]) at baseline and 81.3% (n=135) had improved their glycaemic control at their last follow up appointment.


CONCLUSIONS
In this cohort poor glycaemic control, poor attendance, previous revascularisation and hypertension were associated with higher risk of amputation, with PAD showing a trend. Moreover, we demonstrated benefits in glycaemic control achieved by attending this DFC, which is likely to translate to longer term diabetes related health benefits.
Norwich Medical School, University of East Anglia, Norwich, UK.
A J
AJ
Beaney
Norwich Medical School, University of East Anglia, Norwich, UK.
I
I
Nunney
Diabetic Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
C
C
Gooday
Diabetic Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK. Electronic address: ketan.dhatariya@nnuh.nhs.uk.
K
K
Dhatariya
D000368:Aged; D000671:Amputation, Surgical / Q000639:trends*; D001786:Blood Glucose; D015897:Comorbidity; D017719:Diabetic Foot / Q000150:complications*; D005260:Female; D006748:Hospital Departments; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology*; D007003:Hypoglycemia / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers
D001786:Blood Glucose
Amputation; Clinic attendance; Co-morbidities; Diabetic foot; Hypertension; Risk