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Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients

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Abstract

Treatment strategies for foot at risk and diabetic foot are mainly preventive. Studies describing demographic data, clinical and impacting factors continue to be, however, scarce. Our objective was to determine the epidemiological presentation of diabetic foot and understand whether there were easily assessable variables capable of predicting the development of diabetic foot. This was a retrospective study of 496 patients with established foot at risk or diabetic foot, who were evaluated based on age, gender, type and duration of diabetes, foot at risk classification, and the presence of deformities, ulceration, and amputation. The presence of deformities, ulceration, and amputation was recorded in 45.9, 25.3, and 12.9 % of patients, respectively. As for diabetic foot classification, the great majority of our cohort had diabetic neuropathy (92.9 %). Approximately 30 % had neuro-ischemic disease and only 7.1 % had ischemic disease alone. Sixty-two percent of patients presented neuropathy with no signs of arteriopathy. Foot classification was as a significant predictor for the presence of ulcer (p = 0.009; OR = 3.2; 95 % CI = 1.18–7.3). Only male gender was a significant predictor for ulceration (p < 0.001). Predictors of amputation were male gender (p < 0.001; OR = 3.44 95 % CI = 1.81–6.56) and neuro-ischemic diabetic foot (p < 0.049; OR = 4.6; 95 % CI = 1.01–20.9). The predictors for diabetic foot were male gender and the presence of neuropathy. The combination of neuropathy and peripheral vascular disease adds significantly to the risk for amputation among patients with the diabetic foot syndrome. Men, presenting combined risk factors, should be a group receiving special attention and in the foot clinic, due to their potentially worse evolution.

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Abbreviations

ABI:

Ankle/brachial index

IO:

Ischemic only group

NI:

Neuro-ischemic group

NP:

Neuropathy only group

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil

    Arnaldo Moura Neto, Denise Engelbrecht Zantut-Wittmann & Maria Candida Ribeiro Parisi

  2. Department of Orthopedics, Medical Sciences Faculty, University of Sao Paulo, São Paulo, Brazil

    Tulio Diniz Fernandes

  3. Department of Endocrinology, Medical Sciences Faculty, University of Sao Paulo, São Paulo, Brazil

    Marcia Nery & Maria Candida Ribeiro Parisi

  4. Disciplina de Endocrinologia, Departamento de Clinica Medica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Rua Tessalia Vieira de Camargo, 126, Barao Geraldo, PO Box 13084-971, Campinas, Sao Paulo, Brazil

    Maria Candida Ribeiro Parisi

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  1. Arnaldo Moura Neto
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Correspondence to Maria Candida Ribeiro Parisi.

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Moura Neto, A., Zantut-Wittmann, D.E., Fernandes, T.D. et al. Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients. Endocrine 44, 119–124 (2013). https://doi.org/10.1007/s12020-012-9829-2

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  • DOI: https://doi.org/10.1007/s12020-012-9829-2

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