1. To compare demographic and clinical characteristics of those with and without diabetes that undergo a lower extremity amputation in Glasgow, UK
Fiona Davie-Smith1, Dr Brian Kennon2 Prof Sally Wyke3, Mr Wesley Stuart4, Dr Lorna Paul1, 1School of Medicine, University of Glasgow, 2Diabetes Centre, Southern General Hospital, Glasgow, 3Institute of Health and Wellbeing,
University of Glasgow, 4Vascular Surgery Unit, Western Infirmary, Glasgow
Background
Approximately 84% of lower extremity amputations (LEA) are due to peripheral arterial disease (PAD), and over half of those will have Diabetes Mellitus (DM). Rehabilitation following LEA follows the same model despite the underlying pathology.
Results
The cohort (n=170) had a mean age of 65.9 years. The majority were Caucasian (97%), and half were community ambulatory pre-amputation. Reason for LEA is shown in Table 1, those with DM had more LEAs for ischaemia & infection than those without DM, who had more LEAs for ischaemia alone.
Table 1: Reason For Amputation
%values for given population
Initial level of LEA is shown in Figure 1, 19 participants went onto have revisions to Trans Femoral (TF) level, 6 in those with DM and 13 in those without (NDM).
Figure 1: Number of LEAs by level and diabetes status
Socio-Economic
65% of the cohort live in the two most deprived areas of Glasgow, with no difference between DM and NDM. Other demographic variables of the population are in Table 2.
Table 2: Demographics of Population
%values for given population
Diabetes
Within the DM cohort 80% (n=90) had type II DM and were on the following treatment: 51% insulin, 21% insulin & oral medication, 24% oral medication alone and 4% diet controlled.
Length of Stay
Average length of stay for the whole cohort was 39.2 days from date of amputation. This varied from 36.1 in those with DM to 42.7 in those NDM.
Discussion & Recommendations
Level of amputation is a known predictor of prosthetic rehabilitation (Sansam et al 2009), and there were more trans-tibial amputations in those with DM and more trans-femoral amputations in those without DM. Those with DM stayed in hospital on average 6 days less than those without DM despite reason for amputation being infection & ischaemia. The presence of DM should be considered carefully when managing rehabilitation within the in-patient setting in order to optimise prosthetic fitting.
Future Work
This is the first part in a longitudinal study which follows up the cohort at 6 and 12 months post amputation. Follow up will observe change in morbidities, further amputation surgery, change in social situation, prosthetic fitting, mobility and mortality. This will allow examination of the influence of DM on rehabilitation.
Variable DM
(n=90)
NDM
(n=80)
Total
(n=170)
Males
Females
73% (66)
27% (24)
76% (61)
24% (19)
74% (127)
26% (43)
Lived Alone
36% (32)
41% (33)
38% (65)
Retired
68% (61)
70% (56)
69% (117)
Smokers
61% (55)
89% (71)
74% (126)
Limb Salvaging Surgery
59% (53)
54% (43)
56% (96)
CL Limb Issues
33% (30)
31% (25)
32% (55)
D/C to single room living
51% (46)
51% (41)
51% (87)
Mortality <30 days
6% (5)
6% (10)
Intention to Limb Fit
58% (52)
50% (40)
54% (92)
Purpose
To prospectively outline the population who undergo an LEA in Glasgow and to compare demographic and clinical characteristics of those with DM to those without DM (NDM) with a view to providing diabetes specific rehabilitation. DM
(n=90)
NDM
(n=80)
Total
(n=170)
Infection
12% (18)
7.5% (6)
14% (24)
Ischaemia
29% (26)
79% (63)
52% (89)
Both
51% (46)
14% (11)
33 % (57)
Methods
We conducted a prospective review of all subjects who underwent an LEA in Glasgow between 1st March 2014 and 28th February This involved a review of medical case notes and all other relevant documentation along with a comprehensive assessment of the subjects.
Inclusion criteria were all non traumatic LEAs.
Excluded were LEA’s for trauma, tumour, congenital reasons or orthopaedic complications.
Data collected included Scottish Index of Multiple Deprivation (SIMD) this is divided into 5 quintiles from least to most deprived. Other information such as aetiology, level of amputation, revision surgery, cognition, social support, home environment, contra-lateral (CL) foot problems, education status, co-morbidity, limb fitting intention and for those with diabetes further categorisation of type, treatment and control were also collected. Data Analysis was conducted using SPSS.
References
Sansam, K., Neumann, V., O'Connor, R. and Bhakta, B. (2009) 'Predicting walking ability following lower limb amputation: a systematic review of the literature', J Rehabil Med, 41(8),
Acknowledgements
Ethical approval was given by West of Scotland Research Ethics Committee. This study was funded by Diabetes UK and presented at the WCPT Congress 2015, Singapore.
Contact Details
Fiona Davie-Smith, University of Glasgow