Skip to main content
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Care

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • My Cart

Search

  • Advanced search
Diabetes Care
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
OtherLetters: Observations

Poor Glucose Control in the Year Before Admission as a Powerful Predictor of Amputation in Hospitalized Patients With Diabetic Foot Ulceration

Giuseppe Lepore, Maria L. Maglio, Carlo Cuni, Alessandro R. Dodesini, Italo Nosari, Bruno Minetti, Roberto Trevisan
DOI: 10.2337/dc06-0912 Published 1 August 2006
Giuseppe Lepore
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Find this author on ADS search
  • Find this author on Agricola
  • Search for this author on this site
Maria L. Maglio
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Find this author on ADS search
  • Find this author on Agricola
  • Search for this author on this site
Carlo Cuni
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Find this author on ADS search
  • Find this author on Agricola
  • Search for this author on this site
Alessandro R. Dodesini
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Find this author on ADS search
  • Find this author on Agricola
  • Search for this author on this site
Italo Nosari
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Find this author on ADS search
  • Find this author on Agricola
  • Search for this author on this site
Bruno Minetti
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Find this author on ADS search
  • Find this author on Agricola
  • Search for this author on this site
Roberto Trevisan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Find this author on ADS search
  • Find this author on Agricola
  • Search for this author on this site

Although there is a strong association between lower-extremity amputation (LEA) and HbA1c (A1C) in diabetic patients (1,2), little information is available on glucose control in the period preceding and following LEA (3). Our objective was to evaluate the predictors of LEA and to examine the role of blood glucose control during the year before and the year after admission. A total of 122 diabetic patients (82 men and 40 women aged 69.7 ± 10.9 years, disease duration 19.7 ± 10.4 years) consecutively admitted for diabetic foot ulcers to the Medicine Department of United Hospitals of Bergamo between January 2003 and December 2004 were enrolled in our observational study and assigned to one of three groups.

The prevalence of long-term diabetes complications was similar in each group; >75% had peripheral polyneuropathy, nephropathy, retinopathy, and ischemic cardiomyopathy, and >90% had peripheral vascular disease. Glycemic control was evaluated before and after admission using the mean of three A1C levels measured in the year preceding admission and in the year following discharge. Patients were reevaluated 1 year after admission and assigned to one of three groups: group A, major amputation (n = 28); group B, minor amputation (n = 44); and group C, no amputation (n = 50). Major amputation was defined as amputation above the ankle, and minor amputation was defined as amputation below the ankle.

Data are shown as means ± SD. Categorical variables were compared by χ2 test, continuous variables by ANOVA.

In the year before admission, mean A1C levels were significantly higher in groups A (9.7 ± 1.5%) and B (9.1 ± 1.9%) than in the group C (7.9 ± 1.3%, P < 0.001 vs. A and P < 0.05 vs. B). Similarly at admission, A1C levels were higher in groups A (10.1%) and B (9.4 ± 1.8%) than in the group C (8.1 ± 1.5%, P < 0.001). A1C levels decreased in all groups after 1 year of follow-up: 8.4 ± 1% in group A, 7.9 ± 1.3% in group B, and 7.5 ± 1.2% in group C (P < 0.05 vs. A).

At admission, patients in groups A and B had a higher ulceration grade according to Wagner’s classification (3.9 ± 0.4 and 3.7 ± 0.4, respectively) than those in group C (2.7 ± 1.1, P < 0.001). The prevalence of patients with LDL cholesterol levels <100 mg/dl was significantly lower in groups A (38%) and B (40%) than in group C (65%; P < 0.01 vs. A and P < 0.05 vs. B). More patients in group C (75%, P < 0.05) were on aspirin therapy than in groups A (61%) and B (59%). The frequency of optimal blood pressure control (≤130/80 mmHg) was ∼50% in all groups. Patients in group A (21%, P < 0.001 vs. B and C) received less follow-up with a specialist in a diabetes clinic than patients in the groups B (50%) and C (56%).

Although hypertension and cholesterol levels were inadequately treated, and aspirin therapy underused in a large number of these patients, multivariate logistic regression analysis revealed that only A1C level and ulceration grade were independently associated with LEA.

In conclusion, poor metabolic control and inadequate treatment of modifiable risk factors are powerful predictors of LEA in patients hospitalized for diabetic foot ulcers. We suggest that all diabetic patients with poor metabolic control and risk factors associated with cardiovascular disease receive early referral for education and aggressive treatment with a diabetes clinic.

Footnotes

  • DIABETES CARE

References

  1. Moss SE, Klein R, Klein BEK: The 14-year incidence of lower-extremity amputations in a diabetic population: the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Diabetes Care 22:951–999, 1999
  2. Stratton IM, Adler AI, Neil AW, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR, the UK Prospective Diabetes Study Group: Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 321:406–412, 2000
  3. Miyajima S, Shirai A, Yamamoto S, Okada N, Matsushita T: Risk factors for major limb amputations in diabetic foot gangrene patients. Diabetes Res Clin Pract 71:272–279, 2005

Navigate

  • Current Issue
  • Standards of Care Guidelines
  • Online Ahead of Print
  • Archives
  • Submit
  • Subscribe
  • Email Alerts
  • RSS Feeds

More Information

  • About the Journal
  • Instructions for Authors
  • Journal Policies
  • Reprints and Permissions
  • Advertising
  • Privacy Policy: ADA Journals
  • Copyright Notice/Public Access Policy
  • Contact Us

Other ADA Resources

  • Diabetes
  • Clinical Diabetes
  • Diabetes Spectrum
  • Scientific Sessions Abstracts
  • Standards of Medical Care in Diabetes
  • BMJ Open - Diabetes Research & Care
  • Professional Books
  • Diabetes Forecast

 

  • DiabetesJournals.org
  • Diabetes Core Update
  • ADA's DiabetesPro
  • ADA Member Directory
  • Diabetes.org

© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.