diabetes-related lower-extremity amputation incidence and risk factors: a prospective seven-year study in costa rica incidencia y factores de riesgo de la amputación de extremidades inferiores relacionada con la diabetes: estudio prospectivo de siete años en costa rica

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ID: 147268
2012
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Abstract
OBJECTIVE: To analyze the incidence and determinants of lower-extremity amputation (LEA) in people with diabetes in a low-income community in Costa Rica. METHODS: Data on LEA incidence were collected during a seven-year follow-up (2001-2007) in a diabetes patient cohort (n = 572). Risk factors were analyzed using the Cox proportional hazards regression model and baseline variables from the year 2000 (socio- demographic characteristics, comorbidity, metabolic control, treatment, and chronic microvascular complications). RESULTS: LEA incidence was 6.02 per 1 000 person-years (8.65 in men and 4.50 in women). Known risk factors (sex, years of diabetes, elevated glycated hemoglobin [HbA1c], retinopathy, insulin therapy, and prior amputation) were highly significant. CONCLUSIONS: Those most likely to undergo LEA among Costa Rican diabetic patients were men with 10 or more years of diabetes and average HbA1c > 8% who used insulin and had diabetic retinopathy. Patients on insulin therapy were at greatest risk, especially those with a previous amputation. Diabetic patients with the above-mentioned profile should be considered to be at very high risk of LEA and followed closely by the health care system.
OBJETIVO: Analizar la incidencia y los determinantes de la amputación de extremidades inferiores (AEI) en personas diabéticas de una comunidad con bajos ingresos de Costa Rica. MÉTODOS: Se recopilaron datos sobre la incidencia de la AEI durante un período de seguimiento de siete años (del 2001 al 2007) en una cohorte de pacientes diabéticos (n = 572). Se analizaron los factores de riesgo usando el modelo de regresión de Cox de riesgos proporcionales y los valores de referencia del año 2000 de las variables (características sociodemográficas, comorbilidad, control metabólico, tratamiento y complicaciones microvasculares crónicas). RESULTADOS: La incidencia de la AEI fue de 6,02 por 1 000 personas-año (8,65 en varones y 4,50 en mujeres). Los factores de riesgo conocidos (sexo, años de evolución de la diabetes, glucohemoglobina [HbA1c] elevada, retinopatía, tratamiento con insulina y amputación previa) fueron muy significativos. ONCLUSIONES: Los pacientes diabéticos costarricenses con mayor probabilidad de sufrir una AEI fueron los varones con 10 o más años de evolución de la diabetes y un promedio de HbA1c > 8% que eran tratados con insulina y padecían una retinopatía diabética. Los pacientes en tratamiento con insulina presentaban el mayor riesgo, especialmente los que habían sufrido una amputación anterior. Los pacientes diabéticos con el perfil descrito anteriormente deben considerarse como de riesgo muy elevado de AEI y deben ser seguidos de cerca por el sistema de atención de salud.
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lacl2012revistadiabetes-related Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;Adriana Laclé;Luis F. Valero-Juan
Journal communications on pure and applied analysis
Year 2012
DOI
DOI not found
URL
http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892012000900004
Keywords
Risk factors diabetes mellitus diabetes complications factores de riesgo amputation lower extremity costa rica type 2 tropical medicinepublic aspects of medicine extremidad inferior

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