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Predictors of Major Lower Limb Amputation among Type II Diabetic Patients

S. Karthikeyan* , S. Karthikeyan* , Priya** , Vimal Raj** , Akash***

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New Indian Journal of Surgery 7(3):p 239-243, Sept - Dec 2016. | DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.7316.4

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Abstract

 Diabetes mellitus (DM) is the most common cause of amputations. This study aimed toidentify the predictive factors for major lower limb amputation among patients with type 2 DM (T2DM) who were admitted to our hospital, in order to reduce its likelihood. Methods: This study involved 218 patients with T2DM who were admitted for diabetic foot problems from January 2015 to July 2016. A form was developed to document the patients’ profiles, comorbidities, complications, investigations, treatment and clinical outcomes. The predictors for major lower limb amputations were determined using univariate and stepwise analysis. Results: A total of 31 patients underwent major lower limb amputations (25 transtibial, 6 transfemoral). The followingfactors were found to be associated with the incidence of major lower limb amputations: T2DM duration 10 years, diabetic neuropathy, diabetic nephropathy, presentation with gangrene, diabetic foot conditions of Wagner grade 4 or 5, and necrotising fasciitis. Patients who underwent major amputations had significantly lower haemoglobin and albumin levels, and higher total white blood cell counts, erythrocyte sedimentation rates, and C­reactive protein, urea and creatinine levels. However, only T2DM duration  10 years, positive bacterial culture and albumin levels were significant on stepwise analysis. Conclusion: T2DM duration 10 years, positive bacterial culture and low albumin levels were found to be significantpredictive factors for major lower limb amputation among patients with T2DM admitted for diabetic foot problems.

Keywords: Diabetes Mellitus; Amputation; T2DM; Diabetic Foot.

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DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.7316.4

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