Trends of Below Knee Amputation and Evaluation of Risk Factors- Three Year Study in T2DM

Purpose:
The rising prevalence of Type 2 Diabetes Mellitus (T2DM) with the huge burden of diabetic foot amputation is a challenge to limited healthcare resources.

Material and Methods:
We conducted a retrospective hospital-based study from January 2017 till December 2019 for the T2DM patients who had undergone a non-traumatic, below knee amputation, to evaluate the outcomes and the associated risk factors

Results:
We analyzed a total of 75 patients with diabetes (12 died in due course) who underwent amputation at our center during last 3 years. The mean age of the patients who expired was 63 years (±SD 10, 95% CI 57 to 70) was less than who were alive 64 years (±SD 10, 95% CI 61 to 66); P=0.87 (ns). The mean HbA1c at last follow up, of the patients who expired was 11% (±SD 2.4, 95% CI 9.2 to 9), higher than the alive patients 9.5% (±SD 2.1, 95% CI 9 to 10); P=0.08 (ns). Total of 63 patients were alive (50 males and 13 females). A total of 23 (36.6%) patients were active users of tobacco including smoking, with 22 (35%) had no usage of tobacco ever. Five patients had quit tobacco. A total of 40 patients (63.4%) had no any other co-morbidity, excluding hypertension or peripheral vascular disease (PVD). A total of 39 (62%), 11 (17.4%), 25 (39.6%), 25 (39.6%), 21 (33.3%) patients had PVD, CKD, anemia, systemic hypertension, and ischemic heart disease, respectively. Twenty-two patients were actively using prosthesis, 9 were not the active user of prosthesis as were recently operated in last 3 months. In 25 patients (39.6%), the other limb was normal with no signs of vasculopathy, 2 patients previously had below knee amputation and 15 patients had amputation of the toe.

Conclusions:
We did not find tobacco usage as a predictive risk factor for amputation. There was high prevalence of PVD, hypertension and anemia in patients who underwent below knee amputation. Amputation in the past three years is apparently is a direct risk for the impending amputation in T2DM. Poor glycemic control appears to increase the risk of mortality in T2DM who have undergone below knee amputation. An early adequate glycemic control could decrease the probability the development of microvascular complications and mitigate the disease burden of amputation in limited resource setting.