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© 2001 by the American Diabetes Association, Inc.
Emerging Treatments and Technologies |
New Ulceration, New Major Amputation, and Survival Rates in Diabetic Subjects Hospitalized for Foot Ulceration From 1990 to 1993
A 6.5-year follow-up
From the Internal Medicine Unit (E.F.), Diabetology Center, Policlinico MultiMedica, Sesto San Giovanni; the Internal Medicine Unit (F.F.), Diabetology Center, Niguarda Hospital; and the Institute of Medical Statistics and Biometry (A.M.), the University of Milan, Milan, Italy.
Address correspondence and reprint requests to Ezio Faglia, Internal Medicine Unit, Diabetology Center, Policlinico MultiMedica, Via Milanese 300, Sesto San Giovanni, Milan, Italy. E-mail: ezio.faglia{at}multimedica.it .
OBJECTIVE— To evaluate 1) the new ulceration, the new major amputation, and the survival rates of 115 diabetic subjects hospitalized for foot ulceration from 1990 to 1993, with an average follow-up of 6.5 years, and 2) the demographic and clinical characteristics associated with these events.
RESEARCH DESIGN AND METHODS— A total of 115 subjects, 31 women and 84 men, were monitored until 31 December 1998. All subjects were provided with therapeutic shoes and received intense education. Data concerning new ulceration, new major amputation, and reamputation events and the date and cause of death were recorded for each patient. The prognostic factors for these events were then evaluated.
RESULTS— The average follow-up was 78.3 ± 15.3 months
(range 60-106). During this time, 13 homolateral and 12 contralateral episodes
of new ulceration occurred. At univariate analysis, none of the variables
considered were significantly associated with the new ulceration. There were
three major amputations: two of the limb previously healed and one of the
contralateral limb. Of the 115 subjects, 51 (44.3%) died: 24 of the 31 women
(77.4%) and 27 of the 84 men (32.1%). Ischemic cardiopathy was the most
frequent cause of death (60.8%). Mortality concerned 20 of the 27 subjects
(74.1%) undergoing major amputation from 1990 to 1993 and 31 of the 88 healed
subjects (35.2%), with a significant difference (P < 0.0001).
Multivariate analysis showed the independent role of the ankle-brachial index
0.5 (P = 0.005), age (P = 0.003), and female sex
(P = 0.027).
CONCLUSIONS— We believe that the use of therapeutic shoes and intense educational training, including the education of the family, have contributed to the low incidence of new ulceration and major amputation in our study population. The high frequency of ischemic cardiopathy as a cause of death should, perhaps, lead to a more aggressive diagnostic and therapeutic attitude toward this pathology in diabetic subjects admitted to hospitals for foot ulceration.
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