title: Impact of diabetes on outcome in critical limb ischemia with tissue loss: a large-scaled routine data analysis.
abstract: Patients with diabetes concomitant to critical limb ischemia (CLI) represent a sub-group at particular risk. Objective of this analysis is to evaluate the actual impact of diabetes on treatment, outcome, and costs in a real-world scenario in Germany.
  
  
  
  We obtained routine-data on 15,332 patients with CLI with tissue loss from the largest German health insurance, BARMER GEK from 2009 to 2011, including a follow-up until 2013. Patient data were analyzed regarding co-diagnosis with diabetes with respect to risk profiles, treatment strategy, in-hospital and long-term outcome including costs.
  
  
  
  Diabetic patients received less overall revascularizations in Rutherford grades 5 and 6 (Rutherford grade 5: 45.0 vs. 55.5%; Rutherford grade 6: 46.5 vs. 51.8; p < 0.001) and less vascular surgery (Rutherford grade 5: 13.4 vs. 23.4; Rutherford grade 6: 19.7 vs. 29.6; p < 0.001), however more often endovascular revascularization in Rutherford grade 6 (31.0 vs. 28.1; p = 0.004) compared to non-diabetic patients. Diabetes was associated with a higher observed ratio of infections (35.3 vs. 23.5% Rutherford grade 5; 44.3 vs. 27.4% Rutherford grade 6; p < 0.001) and in-hospital amputations (13.0 vs. 7.3% Rutherford grade 5; 47.5 vs. 36.7% Ruth6; p < 0.001). Diabetes further increased the risk for amputation during follow-up [Rutherford grade 5: HR 1.51 (1.38-1.67); Rutherford grade 6: HR 1.33 (1.25-1.41); p < 0.001], but not for death.
  
  
  
  Diabetes increases markedly the risk of amputation attended by higher costs in CLI patients with tissue loss (OR 1.67 at Rutherford 5, OR 1.53 at Rutherford 6; p < 0.001), but is associated with lower revascularizations. However, in Rutherford grades 5 and 6, concomitant diabetes does not further worsen the overall poor survival.
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany. eva.freisinger@ukmuenster.de.
authors.forename: Eva
authors.initials: E
authors.lastname: Freisinger
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany.
authors.forename: Nasser M
authors.initials: NM
authors.lastname: Malyar
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Reinecke
authors.affiliation: Praxis für Herzkreislauferkrankungen und Akademie für Gefaeßkrankheiten, Ettlingen, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Lawall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D023821:Limb Salvage / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies; D013223:Statistics as Topic / Q000379:methods; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data
keywords: Critical limb ischemia; Diabetes; Epidemiology; Outcome; Routine-data analysis