28 Studies:  Scientific Studies of Diabetes and Amputation

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Words in title only: diabetes And amputation
Published in 1966 through 1999
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Documents: 1 to 28 of 28

1

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Laughlin RT, et al; Syme amputation in patients with severe diabetes mellitus. (Foot Ankle, 1993 Feb, Abstract available) [MEDLINE]

2 Laughlin RT, et al; Syme amputation in patients with severe diabetes mellitus. (Foot Ankle, 1993 Feb, Abstract available) [MEDLINE]
3 Resnick HE, et al; Diabetes mellitus and nontraumatic lower extremity amputation in black and white Americans: the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, 1971-1992. (Arch Intern Med, 1999 Nov, Abstract available) [MEDLINE]
4 Quebedeaux TL, et al; The development of foot deformities and ulcers after great toe amputation in diabetes. (Diabetes Care, 1996 Feb, Abstract available) [MEDLINE]
5 Armstrong DG, et al; Factors associated with bone regrowth following diabetes-related partial amputation of the foot. (J Bone Joint Surg Am, 1999 Nov, Abstract available) [MEDLINE]
6 Lavery LA, et al; Increased foot pressures after great toe amputation in diabetes. (Diabetes Care, 1995 Nov, Abstract available) [MEDLINE]
7 Selby JV, et al; Risk factors for lower extremity amputation in persons with diabetes. (Diabetes Care, 1995 Apr, Abstract available) [MEDLINE]
8 Boulton AJ; Why bother educating the multi-disciplinary team and the patient--the example of prevention of lower extremity amputation in diabetes. (Patient Educ Couns, 1995 Sep, Abstract available) [MEDLINE]
9 Adler AI, et al; Lower-extremity amputation in diabetes. The independent effects of peripheral vascular disease, sensory neuropathy, and foot ulcers. (Diabetes Care, 1999 Jul, Abstract available) [MEDLINE]
10

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Bild DE, et al; Lower-extremity amputation in people with diabetes. Epidemiology and prevention. (Diabetes Care, 1989 Jan, Abstract available) [MEDLINE]

11 Reiber GE, et al; Risk factors for amputation in patients with diabetes mellitus. A case-control study [see comments] (Ann Intern Med, 1992 Jul, Abstract available) [MEDLINE]
12 Ollendorf DA, et al; Potential economic benefits of lower-extremity amputation prevention strategies in diabetes. (Diabetes Care, 1998 Aug, Abstract available) [MEDLINE]
13 Liedberg E, et al; Age, diabetes and smoking in lower limb amputation for arterial occlusive disease. (Acta Orthop Scand, 1983 Jun, Abstract available) [MEDLINE]
14 Falkel JE; Amputation as a consequence of diabetes mellitus. An epidemiological review. (Phys Ther, 1983 Jun, Abstract available) [MEDLINE]
15 Potter PJ, et al; Incidence of peripheral neuropathy in the contralateral limb of persons with unilateral amputation due to diabetes. (J Rehabil Res Dev, 1998 Jul, Abstract available) [MEDLINE]
16 Sanders LJ; Diabetes mellitus. Prevention of amputation [see comments] (J Am Podiatr Med Assoc, 1994 Jul, Abstract available) [MEDLINE]
17 Larsson J, et al; Long-term prognosis after healed amputation in patients with diabetes. (Clin Orthop, 1998 May, Abstract available) [MEDLINE]
18 Humphrey LL, et al; The contribution of non-insulin-dependent diabetes to lower-extremity amputation in the community. (Arch Intern Med, 1994 Apr, Abstract available) [MEDLINE]
19 Kacy SS, et al; Factors affecting the results of below knee amputation in patients with and without diabetes. (Surg Gynecol Obstet, 1982 Oct, Abstract available) [MEDLINE]
20 Lavery LA, et al; Institutionalization following diabetes-related lower extremity amputation. (Am J Med, 1997 Nov, Abstract available) [MEDLINE]
21 Benton GS, et al; Cost effectiveness of early digit amputation in the patient with diabetes. (Surg Gynecol Obstet, 1985 Dec, Abstract available) [MEDLINE]
22 Mueller MJ, et al; Therapeutic footwear: enhanced function in people with diabetes and transmetatarsal amputation. (Arch Phys Med Rehabil, 1997 Sep, Abstract available) [MEDLINE]
23 Lavery LA, et al; Mortality following lower extremity amputation in minorities with diabetes mellitus. (Diabetes Res Clin Pract, 1997 Jul, Abstract available) [MEDLINE]
24 Frykberg RG; Team approach toward lower extremity amputation prevention in diabetes. (J Am Podiatr Med Assoc, 1997 Jul, Abstract available) [MEDLINE]
25 Mueller MJ, et al; Therapeutic footwear can reduce plantar pressures in patients with diabetes and transmetatarsal amputation. (Diabetes Care, 1997 Apr, Abstract available) [MEDLINE]
26 Lee JS, et al; Lower-extremity amputation. Incidence, risk factors, and mortality in the Oklahoma Indian Diabetes Study. (Diabetes, 1993 Jun, Abstract available) [MEDLINE]
27 Gujral JS, et al; Ethnic differences in the incidence of lower extremity amputation secondary to diabetes mellitus. (Diabet Med, 1993 Apr, Abstract available) [MEDLINE]
28 Salsich GB, et al; Relationships between measures of function, strength and walking speed in patients with diabetes and transmetatarsal amputation. (Clin Rehabil, 1997 Feb, Abstract available) [MEDLINE]


 

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Record 1 from database: MEDLINE
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Title
Syme amputation in patients with severe diabetes mellitus.
Author
Laughlin RT; Chambers RB
Address
Division of Orthopaedics, Southern Illinois University, Springfield 62794-9230.
Source
Foot Ankle, 1993 Feb, 14:2, 65-70
Abstract
Surgical results and functional outcome of 52 patients treated with Syme amputations for forefoot gangrene between 1986 and 1988 were retrospectively reviewed with reference to the predictive value of posterior tibial artery Doppler examination. Wound healing was correlated with the preoperative status of the posterior tibial artery. Functional outcome was assessed by the ability to wear a prosthesis, ambulatory capabilities, episodes of ulceration, and revision surgery. Follow-up averaged 27 months. Twenty-nine patients had a posterior tibial artery with either a triphasic waveform (N = 23) or a normal pulse (6). Twenty-six (90%) of these achieved a healed wound suitable for prosthetic wear. Twenty-three patients had monophasic flow in the posterior tibial artery. Thirteen (57%) of these achieved a healed wound. Ninety percent of the patients who achieved healed wounds were fit with a prosthesis. Functional level of ambulation was assessed in 20 patients. Eighteen were community level ambulators, 11 could walk three or more blocks, and 16 could climb stairs. Eighteen wore their prosthesis all day. These findings indicate that posterior tibial artery Doppler examination is predictive of healing in the Syme amputation performed on diabetics. Furthermore, diabetics can attain a functional level of ambulation with a Syme amputation.
Language of Publication
English
Unique Identifier
93202540

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MeSH Heading (Major)
Amputation|*; Diabetes Mellitus|*CO/SU; Foot Diseases|*ET/PA/*SU/US
MeSH Heading
Adult; Aged; Female; Forefoot, Human|PA/SU; Gangrene|ET/SU; Human; Male; Middle Age; Retrospective Studies; Treatment Outcome

Publication Type
JOURNAL ARTICLE; REVIEW; REVIEW OF REPORTED CASES
ISSN
0198-0211
Country of Publication
UNITED STATES

Record 2 from database: MEDLINE
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Title
Syme amputation in patients with severe diabetes mellitus.
Author
Laughlin RT; Chambers RB
Address
Division of Orthopaedics, Southern Illinois University, Springfield 62794-9230.
Source
Foot Ankle, 1993 Feb, 14:2, 65-70
Abstract
Surgical results and functional outcome of 52 patients treated with Syme amputations for forefoot gangrene between 1986 and 1988 were retrospectively reviewed with reference to the predictive value of posterior tibial artery Doppler examination. Wound healing was correlated with the preoperative status of the posterior tibial artery. Functional outcome was assessed by the ability to wear a prosthesis, ambulatory capabilities, episodes of ulceration, and revision surgery. Follow-up averaged 27 months. Twenty-nine patients had a posterior tibial artery with either a triphasic waveform (N = 23) or a normal pulse (6). Twenty-six (90%) of these achieved a healed wound suitable for prosthetic wear. Twenty-three patients had monophasic flow in the posterior tibial artery. Thirteen (57%) of these achieved a healed wound. Ninety percent of the patients who achieved healed wounds were fit with a prosthesis. Functional level of ambulation was assessed in 20 patients. Eighteen were community level ambulators, 11 could walk three or more blocks, and 16 could climb stairs. Eighteen wore their prosthesis all day. These findings indicate that posterior tibial artery Doppler examination is predictive of healing in the Syme amputation performed on diabetics. Furthermore, diabetics can attain a functional level of ambulation with a Syme amputation.
Language of Publication
English
Unique Identifier
93202540

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MeSH Heading (Major)
Amputation|*; Diabetes Mellitus|*CO/SU; Foot Diseases|*ET/PA/*SU/US
MeSH Heading
Adult; Aged; Female; Forefoot, Human|PA/SU; Gangrene|ET/SU; Human; Male; Middle Age; Retrospective Studies; Treatment Outcome

Publication Type
JOURNAL ARTICLE; REVIEW; REVIEW OF REPORTED CASES
ISSN
0198-0211
Country of Publication
UNITED STATES

Record 3 from database: MEDLINE
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Title
Diabetes mellitus and nontraumatic lower extremity amputation in black and white Americans: the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, 1971-1992.
Author
Resnick HE; Valsania P; Phillips CL
Address
Epidemiology, Demography and Biometry Program, National Institute on Aging, Bethesda, MD 20892, USA. resnickh@nih.gov
Source
Arch Intern Med, 1999 Nov, 159:20, 2470-5
Abstract
BACKGROUND: The comparative long-term risk of non-traumatic lower extremity amputation (LEA) in black and white Americans, 2 groups with strikingly different rates of diabetes mellitus, is not known. OBJECTIVE: To examine the 20-year incidence of LEA in relation to race and diabetes mellitus. METHODS: The 14 407 subjects in the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study were observed prospectively between 1971 and 1992. Prevalent diabetes mellitus was ascertained at the baseline examination, and incident diabetes mellitus, during follow-up. Lower extremity amputation was ascertained from hospital discharge records. Cox regression analysis was used to estimate associations between race, diabetes mellitus, and risk of first LEA. RESULTS: During the study period, 158 LEAs occurred among 108 subjects. While black subjects constituted 15.2% of the cohort, they represented 27.8% of the subjects with amputation (P = .002). The 20-year age-adjusted rate ratio of first LEAs for black subjects-white subjects was 2.14. Regression analyses confirmed the importance of diabetes mellitus as a key LEA risk factor. The association between prevalent diabetes mellitus and LEA risk was substantially higher (relative risk [RR], 7.19; 95% confidence interval [CI], 4.61-11.22) than that for incident diabetes mellitus (RR, 3.15 [CI, 1.84-5.37]), highlighting the importance of diabetes mellitus duration on LEA risk. While preliminary analyses adjusted for age and diabetes indicated a significant association between race and LEA risk (RR, 1.93 [95% CI, 1.26-2.96]), the effect of race diminished (RR, 1.49 [95% CI, 0.95-2.34]) following adjustment for education, hypertension, and smoking. CONCLUSIONS: Although black subjects experienced higher age- and diabetes mellitus-adjusted rates of amputation than their white counterparts, a combination of social and environmental factors may account for the apparent ethnic difference. More research into nonbiological factors associated with LEA may reduce the occurrence of these procedures in both black and white individuals.
Language of Publication
English
Unique Identifier
20127662

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MeSH Heading (Major)
Amputation|*SN; Blacks|*SN; Diabetes Mellitus|*CO/*EH/SU; Diabetic Foot|ET/*SU; Leg|*SU; Whites|*SN
MeSH Heading
Adult; Aged; Female; Human; Incidence; Male; Middle Age; Multivariate Analysis; Prevalence; Prospective Studies; Risk; Time Factors; United States|EP

Publication Type
JOURNAL ARTICLE
ISSN
0003-9926
Country of Publication
UNITED STATES

Record 4 from database: MEDLINE
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Title
The development of foot deformities and ulcers after great toe amputation in diabetes.
Author
Quebedeaux TL; Lavery LA; Lavery DC
Address
Department of Orthopaedics, University of Texas Health Science Center, San Antonio 78284-7776, USA.
Source
Diabetes Care, 1996 Feb, 19:2, 165-7
Abstract
OBJECTIVE: Our aim was to compare the prevalence and severity of foot deformities and the development of ulcerations in patients after a great toe amputations. RESEARCH DESIGN AND METHODS: We evaluated the presence of deformities of the toes and metatarsophalangeal joints (MTPJs) in patients with a great toe amputation who had an intact unamputated contralateral foot. The contralateral foot served as the patient's own control. We used a binomial test for paired data to compare the presence of deformity and ulcer formation and Fisher's exact test to compare joint flexibility in toes and MTPJs with foot deformities. RESULTS: There were more deformities of the second (P = 0.012) and third (P = 0.002) toes and lesser MTPJs (P < 0.05) and more rigid deformities of the second (P = 0.002) and third (P = 0.016) toes and second MTPJs (P = 0.035) in feet with great toe amputations. New ulcers were more common in feet that had an amputation (P = 0.002). CONCLUSIONS: We concluded that amputation of the great toe contributes to the development of deformities of the second and third toes and lesser MTPJs and new ulcer formation in patients with diabetes. When deformities were present, the second and third toes and second MTPJ were more severe in feet with a great toe amputation.
Language of Publication
English
Unique Identifier
96351245

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MeSH Heading (Major)
Amputation|*; Diabetic Foot|PP/*SU; Foot Deformities, Acquired|*EP/ET; Toes|*
MeSH Heading
Biomechanics; Body Weight; Comparative Study; Gait; Human; Joints; Prevalence; Recurrence

Publication Type
JOURNAL ARTICLE
ISSN
0149-5992
Country of Publication
UNITED STATES

Record 5 from database: MEDLINE
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Title
Factors associated with bone regrowth following diabetes-related partial amputation of the foot.
Author
Armstrong DG; Hadi S; Nguyen HC; Harkless LB
Address
Department of Orthopaedics, University of Texas Health Science Center at San Antonio, 78284-7776, USA. armstrong@usa.net
Source
J Bone Joint Surg Am, 1999 Nov, 81:11, 1561-5
Abstract
BACKGROUND: The formation of hypertrophic bone after partial resection of metatarsal bone has the potential to cause abnormal foci of high pressure in people who have diabetes mellitus; this may increase the risk of reulceration and reamputation. However, we are not aware of previous studies evaluating the risk factors for this entity. METHODS: The records of ninety-two adults (mean age, 54+/-10.1 years; range, thirty to seventy-four years) with diabetes who had had an isolated partial amputation of a ray were abstracted. Repeat radiographs were made for all of these subjects at a mean of 22+/-6.1 months (range, thirteen to thirty-five months) after the initial procedure. The formation of hypertrophic bone was defined as more than three millimeters of regrowth. RESULTS: A total of forty-one (45 percent) of the subjects had formation of hypertrophic bone at the time of radiographic analysis after isolated partial amputation of a ray. On multivariate analysis, the factors that were significantly associated with this regrowth of bone were male gender (88 percent [thirty-six] of the forty-one patients who had bone regrowth were male compared with 51 percent [twenty-six] of the fifty-one patients who did not have bone regrowth; p<0.01, odds ratio = 5.7, 95 percent confidence interval = 1.8 to 18.9), the use of manual bone-cutting instruments (used in 56 percent [twenty-three] of the forty-one patients who had bone regrowth compared with 16 percent [eight] of the fifty-one who did not; p<0.01, odds ratio = 4.7, 95 percent confidence interval = 1.6 to 13.8), and a resection made distal to the surgical neck of the metatarsal (used in 34 percent [fourteen] of the forty-one patients who had bone regrowth compared with 12 percent [six] of the fifty-one who did not; p<0.03, odds ratio = 4.5, 95 percent confidence interval = 1.2 to 16.9). The patients who had regrowth of bone were approximately eight times more likely to have reulceration at the site of the amputation than were those who did not have regrowth (24 percent [ten] of the patients with regrowth had reulceration compared with 4 percent [two] of the patients without regrowth; p<0.01, chi square = 8.4, odds ratio = 7.9, 95 percent confidence interval = 1.6 to 38.5). CONCLUSIONS: Overgrowth of the bone of a transected metatarsal predisposes patients to ulceration. Male gender, the use of manual bone-cutting instruments, and metaphyseal amputation may be associated with long-term regrowth of bone following isolated partial amputation of a ray. The use of power instruments during these procedures may lead to a lower prevalence of this reaction, thereby potentially reducing the risk of ulceration, infection, and reamputation.
Language of Publication
English
Unique Identifier
20029377

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MeSH Heading (Major)
Amputation|*/IS; Diabetic Foot|RA/*SU; Metatarsal Bones|RA/*SU; Osteogenesis|*PH
MeSH Heading
Adult; Aged; Comparative Study; Confidence Intervals; Female; Follow-Up Studies; Human; Hyperostosis|ET; Male; Middle Age; Multivariate Analysis; Odds Ratio; Osteotomy|IS; Prevalence; Recurrence; Reoperation; Risk Factors; Sex Factors

Publication Type
JOURNAL ARTICLE
ISSN
0021-9355
Country of Publication
UNITED STATES

Record 6 from database: MEDLINE
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Title
Increased foot pressures after great toe amputation in diabetes.
Author
Lavery LA; Lavery DC; Quebedeax Farnham TL
Address
Department of Orthopaedics, University of Texas Health Science Center, San Antonio, USA. lavery@uthscsa.edu
Source
Diabetes Care, 1995 Nov, 18:11, 1460-2
Abstract
OBJECTIVE: To compare peak pressures on the sole of the foot in non-insulin-dependent diabetic patients with isolated, unilateral amputations of the great toe and first metatarsal with the patients' contralateral, intact foot. RESEARCH DESIGN AND METHODS: Eleven patients with a unilateral great toe and partial first metatarsal amputation of at least 6 months duration were evaluated with the F-Scan in-shoe pressure measurement system. Patients were studied in the same brand and style of footwear--a thin, rubber-soled, canvas boat shoe. We compared mean peak plantar foot pressures under the first metatarsal, lesser metatarsals, lesser toes, and heel in feet with and without a great toe amputation using the Wilcoxon's matched pairs signed-rank test. RESULTS: Peak foot pressures were significantly higher under the first metatarsal head (P = 0.046), lesser metatarsal heads (P < 0.001), and toes (P < 0.001) in feet with a great toe amputation compared with the contralateral foot without an amputation. Pressure under the heel was higher on the contralateral foot (P < 0.01). CONCLUSIONS: After a great toe amputation, pressure distribution of the foot is significantly altered. Because preamputation risk factors such as peripheral neuropathy, foot deformity, and limited joint mobility for many of these patients remain unchanged, an increase in foot pressures contributes to an increased risk of reulceration and reamputation in these patients.
Language of Publication
English
Unique Identifier
96352405

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MeSH Heading (Major)
Amputation|*; Diabetes Mellitus, Non-Insulin-Dependent|*PP; Diabetic Foot|*SU; Foot|*PP; Toes|*
MeSH Heading
Adult; Aged; Comparative Study; Diabetic Neuropathies|EP/PC; Female; Human; Male; Middle Age; Pressure; Recurrence; Risk Factors

Publication Type
JOURNAL ARTICLE
ISSN
0149-5992
Country of Publication
UNITED STATES

Record 7 from database: MEDLINE
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Title
Risk factors for lower extremity amputation in persons with diabetes.
Author
Selby JV; Zhang D
Address
Division of Research, Kaiser Permanente Medical Care Program, Oakland, California 94611, USA.
Source
Diabetes Care, 1995 Apr, 18:4, 509-16
Abstract
OBJECTIVE--To determine the predictors of lower extremity amputation (LEA) in a cohort of persons with diabetes (primarily non-insulin-dependent). RESEARCH DESIGN AND METHODS--We conducted a nested case-control study among 10,068 patients from a large health maintenance organization who reported a diagnosis of diabetes at a multiphasic health checkup (MHC) (baseline) between 1964 and 1984. Average length of follow-up after baseline was 13.2 years. Case patients were 150 cohort members with a first, nontraumatic LEA after baseline. Control subjects were 278 cohort members who did not experience an LEA during follow-up, matched to patients on age, sex, and year of baseline MHC. The presence of diabetes at baseline was verified by chart review for both patients and control subjects. Cardiovascular disease risk factors were obtained at the baseline MHC; glucose control, other diabetes-related variables, preventive services, and other complications were obtained from chart review. RESULTS--Level of glucose control (P < 0.0001), duration of diabetes (P = 0.04), and baseline systolic blood pressure (P = 0.004) were independent predictors of amputation, as were microvascular complications (retinopathy, neuropathy, and nephropathy). History of stroke, but not myocardial infarction, was also independently predictive; type of diabetes, cigarette smoking, and total cholesterol level were not. Being African-American was unrelated to amputation risk in univariate or multivariate analyses in this insured population. CONCLUSIONS--LEA shares a risk factor profile with other microvascular complication of diabetes. Thus, control of blood glucose and blood pressure should reduce risk for amputation. African-Americans do not appear to be at increased risk for diabetes-related amputation when access to medical care is comparable.
Language of Publication
English
Unique Identifier
96001856

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MeSH Heading (Major)
Amputation|*; Diabetic Angiopathies|BL/EH/*SU; Leg|*SU
MeSH Heading
Blacks; Blood Glucose|ME; Blood Pressure; Case-Control Studies; Female; Human; Male; Middle Age; Multivariate Analysis; Prospective Studies; Risk Factors; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.

Publication Type
JOURNAL ARTICLE
ISSN
0149-5992
Country of Publication
UNITED STATES

Record 8 from database: MEDLINE
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Title
Why bother educating the multi-disciplinary team and the patient--the example of prevention of lower extremity amputation in diabetes.
Author
Boulton AJ
Address
 
Source
Patient Educ Couns, 1995 Sep, 26:1-3, 183-8
Abstract
Amongst all the long-term complications of diabetes it is believed that foot ulceration and amputation are the most preventable: small studies have suggested that more than 50% of amputations should be avoidable by screening and appropriate education. There is ample evidence that simple non-invasive screening tests are not being carried out in many diabetic clinics--one study confirmed that poor patient care was responsible for 50% of heel ulcers in a hospital setting. There is a similar lack of awareness of potential problems in many 'at risk' diabetic patients. Thus, simple screening of diabetic patients should be routine clinical practice: those identified as being at 'high risk' of foot, problems should receive appropriate education in protective foot care. The rewards are potentially great, and include the realization of the St. Vincent target, a 50% reduction in amputation.
Language of Publication
English
Unique Identifier
96037481

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MeSH Heading (Major)
Amputation|*RH; Diabetes Mellitus|CO/*PC; Health Occupations|*ED; Patient Care Team|*; Patient Education|*/*MT
MeSH Heading
Diabetic Foot|PC; Human; Skin Care

Publication Type
JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL
ISSN
0738-3991
Country of Publication
IRELAND

Record 9 from database: MEDLINE
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Title
Lower-extremity amputation in diabetes. The independent effects of peripheral vascular disease, sensory neuropathy, and foot ulcers.
Author
Adler AI; Boyko EJ; Ahroni JH; Smith DG
Address
Health Services Research and Development Program, Veterans Affairs Puget Sound Health Care System, Washington, USA. amanda.adler@drl.ox.ac.uk
Source
Diabetes Care, 1999 Jul, 22:7, 1029-35
Abstract
OBJECTIVE: To identify risk factors for lower-extremity amputation (LEA) in individuals with diabetes and to estimate the incidence of LEA. RESEARCH DESIGN AND METHODS: This is a prospective study of 776 U.S. veterans in a general medicine clinic in Seattle, Washington. The outcome was first LEA during follow-up. Potential risk factors evaluated in proportional hazards models included, among others, peripheral vascular disease (PVD), sensory neuropathy, former LEA, foot deformities and ulcers, diabetes duration and treatment, and hyperglycemia. RESULTS: Associated with an increased risk for LEA were PVD defined as transcutaneous oxygen < or = 50 mmHg (relative risk [RR] = 3.0, 95% CI 1.3-7.1), insensitivity to monofilament testing (RR = 2.9, odds ratio = 1.1-7.8), lower-extremity ulcers (RR = 2.5, CI 1.1-5.4), former LEA, and treatment with insulin when controlling for duration of diabetes and other factors in the model. PVD defined as absent or diminished lower-extremity pulses or an ankle arm index < or = 0.8 was also associated with a significantly higher risk of LEA in separate models. Foot ulcers were associated with an increased ipsilateral risk of amputation. The age-adjusted incidence among men only for LEA standardized to the 1991 U.S. male diabetic population was 11.3/1,000 patient-years. CONCLUSIONS: This prospective study shows that peripheral sensory neuropathy, PVD, foot ulcers (particularly if they appear on the same side as the eventual LEA), former amputation, and treatment with insulin are independent risk factors for LEA in patients with diabetes.
Language of Publication
English
Unique Identifier
99317193

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MeSH Heading (Major)
Amputation|*SN; Diabetic Angiopathies|*PP; Diabetic Foot|EP/*SU; Diabetic Neuropathies|*PP; Foot Ulcer|*PP
MeSH Heading
Adult; Aged; Aged, 80 and over; Analysis of Variance; Diabetes Mellitus, Insulin-Dependent|PP; Diabetes Mellitus, Non-Insulin-Dependent|PP; Female; Follow-Up Studies; Hospitals, Veterans; Human; Incidence; Male; Middle Age; Military Personnel; Models, Statistical; Multivariate Analysis; Prospective Studies; Risk; Risk Factors; Support, U.S. Gov't, Non-P.H.S.; Time Factors; United States

Publication Type
JOURNAL ARTICLE
ISSN
0149-5992
Country of Publication
UNITED STATES

Record 10 from database: MEDLINE
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Title
Lower-extremity amputation in people with diabetes. Epidemiology and prevention.
Author
Bild DE; Selby JV; Sinnock P; Browner WS; Braveman P; Showstack JA
Address
Division of Diabetes Control, Center for Disease Control, Atlanta, Georgia 30333.
Source
Diabetes Care, 1989 Jan, 12:1, 24-31
Abstract
The age-adjusted rate of lower-extremity amputation (LEA) in the diabetic population is approximately 15 times that of the nondiabetic population. Over 50,000 LEAs were performed on individuals with diabetes in the United States in 1985. Among individuals with diabetes, peripheral neuropathy and peripheral vascular disease (PVD) are major predisposing factors for LEA. Lack of adequate foot care and infection are additional risk factors. Several large clinical centers have experienced a 44-85% reduction in the rate of amputations among individuals with diabetes after the implementation of improved foot-care programs. Programs to reduce amputations among people with diabetes in primary-care settings should identify those at high risk; clinically evaluate individuals to determine specific risk status; ensure appropriate preventive therapy, treatment for foot problems, and follow-up; provide patient education; and, when necessary, refer patients to specialists, including health-care professionals for diagnostic and therapeutic interventions and shoe fitters for proper footwear. Programs should monitor and evaluate their activities and outcomes. Many issues related to the etiology and prevention of LEAs require further research.
Language of Publication
English
Unique Identifier
89231372

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MeSH Heading (Major)
Amputation|*SN; Diabetic Angiopathies|*CO/PC; Diabetic Neuropathies|*CO/PC; Foot Diseases|ET/PC/*SU; Gangrene|ET/PC/*SU
MeSH Heading
Aged; Comparative Study; Female; Human; Male; Middle Age; Patient Education; Risk Factors; Support, Non-U.S. Gov't; United States

Publication Type
JOURNAL ARTICLE
ISSN
0149-5992
Country of Publication
UNITED STATES

Record 11 from database: MEDLINE
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Title
Risk factors for amputation in patients with diabetes mellitus. A case-control study [see comments]
Author
Reiber GE; Pecoraro RE; Koepsell TD
Address
Health Services Research & Development, Seattle VA Medical Center, WA 98108.
Source
Ann Intern Med, 1992 Jul, 117:2, 97-105
Abstract
OBJECTIVE: To identify and quantify risk factors for lower extremity amputation in persons with diabetes mellitus. DESIGN: Case-control study. SETTING: A Veterans Affairs medical center. PATIENTS: Eighty patients having amputation associated with diabetes and 236 diabetic controls without limb lesions were enrolled before surgery from the 21,167 inpatient care and outpatient surgical patients seen at the Seattle Veterans Affairs Medical Center during a 30-month period. MEASUREMENTS: Selected vascular, neuropathic, environmental, health care, self care, nutritional, metabolic, lifestyle, and psychosocial risk factors were measured in all patients before surgery. RESULTS: Statistically significant risk factors identified from analysis included insufficient mean below-knee and foot cutaneous circulation (odds ratio, 161; 95% CI, 55.1 to 469); ankle-arm blood pressure index less than 0.45 (odds ratio, 55.8; CI, 14.9 to 209); absence of lower leg vibratory perception (odds ratio, 15.5; CI, 8.3 to 28.7); low levels of high-density lipoprotein (HDL) subfraction 3 less than or equal to 0.7 mumol/L (odds ratio, 4.9; CI, 2.9 to 8.3); and no previous outpatient diabetes education (odds ratio, 3.2; CI, 1.6 to 6.6). A logistic regression analysis done to control for the potentially confounding effects of age; race; socioeconomic status; diabetes duration, type, and severity confirmed these findings and added a statistically significant interaction between foot transcutaneous oxygen tension and peripheral vascular disease history. Clinical interventions to alter these risk factors were identified, including aggressive treatment of infection, diabetes education, protective footwear, and preventive footcare. CONCLUSIONS: Multiple risk factors exist along the continuum of conditions and events leading to lower extremity amputation in diabetes. Modification of certain risk factors by patients and health professionals may reduce the risk for amputation and thus decrease the human and dollar costs that accompany limb loss in this prevalent chronic disease.
Language of Publication
English
Unique Identifier
92296442

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MeSH Heading (Major)
Amputation|*; Diabetes Mellitus|*CO/PP; Leg|PP/*SU
MeSH Heading
Adult; Aged; Aged, 80 and over; Case-Control Studies; Human; Knowledge, Attitudes, Practice; Logistic Models; Male; Middle Age; Risk Factors; Social Support; Statistics; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.

Publication Type
JOURNAL ARTICLE
ISSN
0003-4819
Country of Publication
UNITED STATES

Record 12 from database: MEDLINE
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Title
Potential economic benefits of lower-extremity amputation prevention strategies in diabetes.
Author
Ollendorf DA; Kotsanos JG; Wishner WJ; Friedman M; Cooper T; Bittoni M; Oster G
Address
Policy Analysis Incorporated, Brookline, Massachusetts, USA.
Source
Diabetes Care, 1998 Aug, 21:8, 1240-5
Abstract
OBJECTIVE: To estimate the potential economic benefits of selected strategies from published literature--educational interventions, multidisciplinary clinics, and insurance coverage for therapeutic shoes--to reduce the incidence of lower-extremity amputation among individuals with diabetes. RESEARCH DESIGN AND METHODS: We developed a model to estimate the expected incidence and associated costs of lower-extremity amputation in a hypothetical cohort of 10,000 people with diabetes. Prevention strategies were assumed to be targeted at individuals with a history of foot ulcer, and benefits were estimated over a period of 3 years. RESULTS: The total potential economic benefits (discounted at 5%) of strategies to reduce amputation risk ranged from $2.0 to $3.0 million ($2,900 to $4,442 per person with a history of foot ulcer) over 3 years. Benefits were highest for educational interventions. Most benefits were found to accrue among individuals aged > or = 70 years. CONCLUSIONS: Strategies to reduce the risk of lower-extremity amputation may generate substantial economic benefits and should be a standard component of routine diabetes care. Benefits may best be achieved through a partnership of government, private payers, health care service providers and producers, and individuals with diabetes.
Language of Publication
English
Unique Identifier
98367804

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MeSH Heading (Major)
Amputation|*EC/*SN; Diabetes Mellitus|EC/*TH; Diabetic Foot|EC/EP/*PC; Leg|*; Patient Education|*
MeSH Heading
Age Factors; Cohort Studies; Cost-Benefit Analysis; Education, Continuing; Foot Ulcer|EC/PC; Health Personnel|ED; Human; Incidence; Models, Statistical; Reproducibility of Results; Shoes|EC; Support, Non-U.S. Gov't; United States|EP

Publication Type
JOURNAL ARTICLE
ISSN
0149-5992
Country of Publication
UNITED STATES

Record 13 from database: MEDLINE
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Title
Age, diabetes and smoking in lower limb amputation for arterial occlusive disease.
Author
Liedberg E; Persson BM
Address
 
Source
Acta Orthop Scand, 1983 Jun, 54:3, 383-8
Abstract
The increased number of amputations for arterial occlusive disease noted in western countries is only partly explained by increasing numbers of the elderly. A prospective analysis of the influence of diabetes and smoking habits was therefore carried out. In 1978-81, 188 lower limb amputees in Lund were examined and classified as non-smokers, ex-smokers, light smokers and heavy smokers. These figures were compared with corresponding figures among age-correlated controls and to a group of hip fracture patients. The material was divided into men and women and into non-diabetics and diabetics. Smokers had much lower mean age at amputation. Out of 188 amputees only 23 were not either a diabetic, a smoker or 80 years or more. The population study indicates a correlation between smoking and amputation for ichaemia. The coincident increase in cigarette consumption in Sweden is illustrated and it is suggested that smoking should be noted as routinely as diabetes at amputations.
Language of Publication
English
Unique Identifier
83227096

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MeSH Heading (Major)
Amputation|*; Arterial Occlusive Diseases|*CO/SU; Diabetes Mellitus|*CO; Smoking|*
MeSH Heading
Adult; Age Factors; Aged; Comparative Study; Epidemiologic Methods; Female; Hip Fractures|SU; Human; Leg; Male; Middle Age; Prospective Studies; Support, Non-U.S. Gov't; Sweden

Publication Type
JOURNAL ARTICLE
ISSN
0001-6470
Country of Publication
DENMARK

Record 14 from database: MEDLINE
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Title
Amputation as a consequence of diabetes mellitus. An epidemiological review.
Author
Falkel JE
Address
 
Source
Phys Ther, 1983 Jun, 63:6, 960-4
Abstract
Amputation as a consequence of diabetes mellitus is becoming an increasingly serious public health problem and a problem that is commonly treated in the physical therapy clinic. Traditionally, physical therapists have devoted most of their efforts to treating the residual limb and have neglected caring for the other leg. This review examines the epidemiology of diabetic gangrene with consequent amputation and provides ideas for preventive measures and research directed at decreasing the occurrence of gangrene and its complications.
Language of Publication
English
Unique Identifier
83221990

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MeSH Heading (Major)
Amputation|*; Diabetic Angiopathies|CO/EP/*SU; Leg|BS/*SU
MeSH Heading
Age Factors; Aged; Artificial Limbs; Female; Gangrene|EP/ET/SU; Human; Male; Middle Age; Reoperation; Risk; Sex Factors

Publication Type
JOURNAL ARTICLE
ISSN
0031-9023
Country of Publication
UNITED STATES

Record 15 from database: MEDLINE
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Title
Incidence of peripheral neuropathy in the contralateral limb of persons with unilateral amputation due to diabetes.
Author
Potter PJ; Maryniak O; Yaworski R; Jones IC
Address
Department of Physical Medicine and Rehabilitation, Parkwood Hospital, University of Western Ontario, London, Canada.
Source
J Rehabil Res Dev, 1998 Jul, 35:3, 335-9
Abstract
Eighty persons with first-time, nontraumatic amputation, mean age 66.7 yrs +/- 12.6 (1 SD) were examined to determine the extent of peripheral neuropathy (PN) present in the intact limb. Thirty-eight (47.5%) of the subjects had confirmed diabetes mellitus (DM); in those subjects, vibration sense (73.3%), temperature sense (42.1%), and nociception (71.1%) were decreased or absent in the intact limb. The prevalence of sensory impairment was significantly less in nondiabetic subjects in whom vibration sense 46.5% (p < 0.02), temperature sense 16.3% (p < 0.01), and nociception 32.6% (p < 0.02) were decreased or absent. Using a scale that stages the severity of PN, a significant difference (p < 0.001) in the distribution was found between these two groups. Only one person with known DM had no evidence of PN. Twenty-eight out of 42 nondiabetic subjects had evidence of PN. Eighty percent of all subjects had PN. This study confirms the significant potential for PN in persons with DM and presents new evidence of a significant incidence of neuropathy in nondiabetic individuals with amputation. The finding of unexpected peripheral nerve compromise is an important consideration in the treatment of persons with peripheral vascular disease who are at risk for amputation and for persons with amputation who depend on the intact limb for stability and ambulation.
Language of Publication
English
Unique Identifier
98369940

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MeSH Heading (Major)
Amputation|*; Diabetic Angiopathies|*CO/*SU; Diabetic Neuropathies|*CO
MeSH Heading
Aged; Female; Human; Male; Middle Age; Prospective Studies

Publication Type
JOURNAL ARTICLE
ISSN
0748-7711
Country of Publication
UNITED STATES

Record 16 from database: MEDLINE
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Title
Diabetes mellitus. Prevention of amputation [see comments]
Author
Sanders LJ
Address
Podiatry Section, Veterans Affairs Medical Center, Lebanon, PA 17042.
Source
J Am Podiatr Med Assoc, 1994 Jul, 84:7, 322-8
Abstract
Fifteen percent of individuals with diabetes will likely develop foot ulcers in their lifetime, and approximately 15% to 20% of these ulcers are estimated to result in lower extremity amputation. Techniques to prevent lower extremity amputation range from the simple but often neglected foot inspection to complicated vascular and reconstructive foot surgery. Appropriate management can prevent and heal diabetic foot ulcers, thereby greatly decreasing the amputation rate and medical care costs. Prevention is the key to treatment. The author discusses general guidelines for foot screening and identifies three specific goals for prevention of amputation: 1) identification of at risk individuals needing prevention and the specific factors placing them at risk; 2) protection of the foot against the adverse effects of external forces (pressure, friction, and shear); and 3) reduction of the incidence of diabetic foot ulcers through educational programs.
Language of Publication
English
Unique Identifier
94343236

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MeSH Heading (Major)
Diabetic Foot|*/DI/PC/TH
MeSH Heading
Amputation; Foot|SU; Human

Publication Type
JOURNAL ARTICLE
ISSN
8750-7315
Country of Publication
UNITED STATES

Record 17 from database: MEDLINE
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Title
Long-term prognosis after healed amputation in patients with diabetes.
Author
Larsson J; Agardh CD; Apelqvist J; Stenström A
Address
Department of Orthopedics, University Hospital, Lund, Sweden.
Source
Clin Orthop, 1998 May, :350, 149-58
Abstract
In this prospective study, mortality, rehabilitation, and new amputations on the same or on the contralateral leg were studied in 189 patients with diabetes who had achieved healing of an index amputation. Ninety-three patients had achieved healing after an index minor (below the ankle) and 96 after an index major (above the ankle) amputation, precipitated by a foot ulcer. The healing time was 29 weeks (range, 3-191 weeks) with a minor amputation and 8 weeks (range, 3-104 weeks) with a primary major amputation. The mortality 1, 3, and 5 years after the index amputation was 15%, 38%, and 68%, respectively, and was higher in patients who had achieved healing after major amputation than in patients achieving healing after minor amputation. The rate of new amputations after 1, 3, and 5 years of observation was 14%, 30%, and 49%, respectively. There was no difference among patients with an index minor and those with an index major amputation. The rate of new major amputations was 9%, 13%, and 23%, respectively, and was higher in patients with an index major amputation. Eighty-five percent of new amputations were precipitated by a foot ulcer. Patients living independently before the index amputation returned to living independently more often after a minor than a major amputation (93% versus 61%). One year after the index amputation, 70% of patients who had achieved healing after having a minor amputation and who could walk 1 km or more before amputation had regained this walking capacity, compared with 19% of patients having a major amputation. Seventy percent of patients with an index transtibial amputation who could walk before amputation were fitted with a prosthesis, and 52% were using it regularly. Patients with diabetes who had an index major amputation had a higher mortality, an equal rate of new amputation, and a lower rehabilitation potential than did patients who had an index minor amputation.
Language of Publication
English
Unique Identifier
98265524

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MeSH Heading (Major)
Amputation|*; Diabetic Foot|RH/*SU; Foot|*SU
MeSH Heading
Adult; Aged; Aged, 80 and over; Human; Middle Age; Prognosis; Prospective Studies; Support, Non-U.S. Gov't; Treatment Outcome

Publication Type
JOURNAL ARTICLE
ISSN
0009-921X
Country of Publication
UNITED STATES

Record 18 from database: MEDLINE
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Title
The contribution of non-insulin-dependent diabetes to lower-extremity amputation in the community.
Author
Humphrey LL; Palumbo PJ; Butters MA; Hallett JW Jr; Chu CP; OFallon WM; Ballard DJ
Address
Section of General Medicine, Veterans Affairs Medical Center, Oregon Health Sciences University, Portland.
Source
Arch Intern Med, 1994 Apr, 154:8, 885-92
Abstract
BACKGROUND: Despite the significant public health burden of lower-extremity amputations in diabetes mellitus, few data are available on the epidemiology of lower-extremity amputations in diabetes mellitus in the community setting. METHODS: A retrospective incidence cohort study based in Rochester, Minn, was conducted. RESULTS: Among the 2015 diabetic individuals free of lower-extremity amputation at the diagnosis of diabetes mellitus, 57 individuals underwent 79 lower-extremity amputations (incidence, 375 per 100,000 person-years; 95% confidence interval, 297 to 467). Among the 1826 patients with non-insulin-dependent diabetes mellitus, 52 underwent 73 lower-extremity amputations, and the subsequent incidence of lower-extremity amputation among these residents was 388 per 100,000 person-years (95% confidence interval, 304 to 487). Of the 137 insulin-dependent diabetic patients, four subsequently underwent five lower-extremity