Risk factors for diabetes amputation

NewsBot · Nov 6, 2024

The Risk of and Associated Demographic and Laboratory Variables for Amputations for Inpatients with Diabetic Foot Ulcers
Shiming Xu, et al
Source

Diabetic foot ulcers (DFUs) are a leading cause of morbidity and mortality, which disproportionately impacts underserved populations. This study aimed to provide data regarding the rates and outcomes of amputation in patients admitted with DFU in our health system, which cares for an ethnically diverse and underserved population.
Methods
This retrospective study examined the electronic medical records of adult patients hospitalized with DFU at 3 hospitals in our health system between June 1, 2016, and May 31, 2021.
Results
Among 650 patients admitted with DFU, 88% self-identified as non-White race. Male sex (odds ratio [OR], 0.62), low body mass index (OR, 0.98), and history of smoking (OR, 1.45) were significantly associated with amputation during the study period. A higher erythrocyte sedimentation rate (OR, 1.01), C-reactive protein level (OR, 1.05), and white blood cell count (OR, 1.11) and low albumin level (OR, 0.41) were found to be significantly associated with amputation versus no amputation during admission. The amputation risk during the index admission for DFU was 44%.
Conclusion
Our study identified a high DFU-related amputation risk (44%) among adult patients who were mostly Black and/or Hispanic. The significant risk factors associated with DFU amputation included male sex, low body mass index, smoking, and high levels inflammation or low levels of albumin during admission. Many of these patients required multidisciplinary care and intravenous antibiotic therapy, necessitating a longer length of stay and high readmission rate.
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NewsBot · Nov 10, 2024

Risk Factors Associated with Amputation for
Patients with Diabetic Foot Ulcers:
A Retrospective Study
Bo Yang et al
Source

Objective: Diabetic foot ulcer (DFU) and related amputation significantly contribute to morbidity rates. The objective of this study
was to assess the risk factors correlated with amputation in Chinese patients with DFU.
Methods: A prospective study was implemented on DFU patients at Third Affiliated Hospital of Anhui Medical University from
February 2016 to May 2024. Patients were categorized into two groups based on whether they underwent amputation: the amputation
group (n = 33) and the non-amputation group (n = 29). A comparative analysis was conducted between two groups, focusing on
demographic data, disease characteristics, and laboratory indicators. Binary and multivariate logistic regressions were employed to
evaluate the risk factors associated with amputation. Receiver Operating Characteristic curve analysis was used to assess the risk
factors in predicting amputation in patients with DFU.
Results: The incidence of history of amputation, duration of diabetes in the amputation group were significantly increased compared
to the non-amputation group (P < 0.05). On the contrary, the red blood cell count, hemoglobin level, and hematocrit in the amputation
group were significantly lower compared to the non-amputation group (P < 0.05). Moreover, in the bi-variable logistic regression
analysis, the duration of diabetes, duration of DFU, history of amputation, and hemoglobin levels were significantly associated with
amputation (P < 0.05). After controlling potential confounding factors in multiple logistic regression analysis, duration of DFU was
identified as a determining factor for amputation (P < 0.05). Additionally, the values for the area under curve (AUC) in relation to the
duration of diabetes, duration of DFU, history of amputation, and a combined panel in predicting the occurrence of amputation in
patients with DFU were 0.890, 0.868, 0.730, and 0.916, respectively.
Conclusion: Our findings indicate that duration of DFU is an independent risk factor for amputation in patients with DFU.
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NewsBot · Nov 13, 2024

Risk Factors Associated with Amputation for Patients with Diabetic Foot Ulcers: A Retrospective Study
Bo Yang et al
Diabetes Metab Syndr Obes. 2024 Nov 7:17:4201-4209

Objective: Diabetic foot ulcer (DFU) and related amputation significantly contribute to morbidity rates. The objective of this study was to assess the risk factors correlated with amputation in Chinese patients with DFU.

Methods: A prospective study was implemented on DFU patients at Third Affiliated Hospital of Anhui Medical University from February 2016 to May 2024. Patients were categorized into two groups based on whether they underwent amputation: the amputation group (n = 33) and the non-amputation group (n = 29). A comparative analysis was conducted between two groups, focusing on demographic data, disease characteristics, and laboratory indicators. Binary and multivariate logistic regressions were employed to evaluate the risk factors associated with amputation. Receiver Operating Characteristic curve analysis was used to assess the risk factors in predicting amputation in patients with DFU.

Results: The incidence of history of amputation, duration of diabetes in the amputation group were significantly increased compared to the non-amputation group (P < 0.05). On the contrary, the red blood cell count, hemoglobin level, and hematocrit in the amputation group were significantly lower compared to the non-amputation group (P < 0.05). Moreover, in the bi-variable logistic regression analysis, the duration of diabetes, duration of DFU, history of amputation, and hemoglobin levels were significantly associated with amputation (P < 0.05). After controlling potential confounding factors in multiple logistic regression analysis, duration of DFU was identified as a determining factor for amputation (P < 0.05). Additionally, the values for the area under curve (AUC) in relation to the duration of diabetes, duration of DFU, history of amputation, and a combined panel in predicting the occurrence of amputation in patients with DFU were 0.890, 0.868, 0.730, and 0.916, respectively.

Conclusion: Our findings indicate that duration of DFU is an independent risk factor for amputation in patients with DFU.
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NewsBot · Nov 15, 2024

Analysis of clinical characteristics in patients with diabetic foot ulcers undergoing amputation and establishment of a nomogram prediction model
Tiantian Xu et al
Sci Rep. 2024 Nov 14;14(1):27934

To assess the accuracy of a nomogram for predicting the risk of lower-extremity amputation (LEA) in individuals with diabetic foot ulcers (DFUs). We retrospectively analyzed data from 144 patients with DFUs at the Department of Orthopedics of the First Affiliated Hospital of Nanchang University, collected between January 2020 and December 2023. Univariate analysis determined primary predictive factors for amputation, followed by single and multifactor logistic regression analyses to indentify independent factors. These were utilized to develop a prediction model using R4.3.3, and a nomogram was created. Its performance was verified using receiver operating characteristic (ROC), corrected calibration, and clinical decision curves. Twelve primary predictive factors were identified from 20 variables, including age, Wagner grades, peripheral angiopathy of diabetes (PAD), chronic kidney disease(CKD), C-reactive protein(CRP) and the number of blood sugar abnormalities(BSA) etc. Multivariate logical regression analysis illustrated that Wagner grades, PAD, CRP, CKD, and the number of BSA were independent risk factors. The area under the curve (AUC) of the ROC curve was 0.967, and the revised calibration curve of the nomogram demonstrated strong fitting ability. This prediction model is a valuable tool for screening LEA risk and preventing DFU from progressing into amputation.
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NewsBot · Dec 7, 2024

Risk Factors for Lower Extremity Amputation among Diabetic Patients with Diabetic Foot Gangrene in ATBUTH, Bauchi
Stephen Yusuf et al
Open Journal of Orthopedics > Vol.14 No.9, September 2024

Background: Diabetic mellitus was described as an evolving global epidemic of the twenty-first century, due to the exponential rise in the number of people with the condition. Lower extremity amputation is one of the common complications of diabetes. With increase in the number of people with diabetes there will also be increase in the number of diabetics going for lower extremity amputation, increasing both the financial as well as psychologic burden of treatment. Methodology: A prospective cross-sectional study of all diabetic patients going for lower extremity amputation will be done. All the patients with advanced diabetic foot syndrome needing lower extremity amputation are enrolled (Wagener stage IV and V), both through the clinic and emergency center. Informed consent is obtained from the patient after which data are collected using a structured questionnaire. All the investigation results of the patients were also documented. Data collected are analyzed using the SPSS version 29. Chi-square and student t-test were used to measure significant relationship between the variables at 95% confident interval. Results: Within the period of study, which extends from 1st January 2022 to 1st of January 2024, a total of 171 patients were recruited. All diabetic patients with diabetic foot Wagener grade IV and V who presented to the clinic or emergency department were enrolled in the study. We found a significant relationship between gender, previous procedure on the affected limb or amputation of the contralateral limb, knowledge of foot care among diabetics and risk of amputation. There was, however, no statistically significant relationship between. There is no statistically significance relationship between the level of education, occupation, presence of co-morbidity with the risk of amputation among diabetic patients with foot syndrome. Conclusion: Previous lower limb procedure/amputation, male gender, paucity of knowledge on foot care, prolonged duration of the disease and method of treatment are important risk factors for the risk of amputation among diabetic patients with diabetic foot syndrome.
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NewsBot · Dec 24, 2024

Development of a major amputation prediction model and nomogram in patients with diabetic foot
Yi Chen, Jun Zhuang, Caizhe Yang
Postgraduate Medical Journal, Volume 100, Issue 1190, December 2024, Pages 908–916, https://doi.org/10.1093/postmj/qgae087

Background
Diabetes mellitus, as one of the world’s fastest-growing diseases, is a chronic metabolic disease that has now become a public health problem worldwide. The purpose of this research was to develop a predictive nomogram model to demonstrate the risk of major amputation in patients with diabetic foot.

Methods
A total of 634 Type 2 Diabetes Mellitus (T2DM) patients with diabetic foot ulcer hospitalized at the Air Force Medical Center between January 2018 and December 2023 were included in our retrospective study. There were 468 males (73.82%) and 166 females (26.18%) with an average age of 61.64 ± 11.27 years and average body mass index of 24.45 ± 3.56 kg/m2. The predictive factors were evaluated by single factor logistic regression and multiple logistic regression and the predictive nomogram was established with these features. Receiver operating characteristic (subject working characteristic curve) and their area under the curve, calibration curve, and decision curve analysis of this major amputation nomogram were assessed. Model validation was performed by the internal validation set, and the receiver operating characteristic curve, calibration curve, and decision curve analysis were used to further evaluate the nomogram model performance and clinical usefulness.

Results
Predictors contained in this predictive model included body mass index, ulcer sites, hemoglobin, neutrophil-to-lymphocyte ratio, blood uric acid (BUA), and ejection fraction. Good discrimination with a C-index of 0.957 (95% CI, 0.931–0.983) in the training group and a C-index of 0.987 (95% CI, 0.969–1.000) in the validation cohort were showed with this predictive model. Good calibration were displayed. The decision curve analysis showed that using the nomogram prediction model in the training cohort and validation cohort would respectively have clinical benefits.

Conclusion
This new nomogram incorporating body mass index, ulcer sites, hemoglobin, neutrophil-to-lymphocyte ratio, BUA, and ejection fraction has good accuracy and good predictive value for predicting the risk of major amputation in patients with diabetic foot.
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NewsBot · Jan 6, 2025

Influencing factors analysis and prediction model establishment of toe-amputation in patients with diabetic foot
D Zhu et al
Zhonghua Yi Xue Za Zhi. 2025 Jan 7;105(1):63-71.

Objective: To analyze the influencing factors of toe-amputation in diabetic foot patients and construct a predictive model. Methods: The clinical data of 437 diabetic foot patients who were hospitalized in Air Force Medical Center from January 2017 to January 2024 were retrospectively analyzed, including 327 males and 110 females, with a median age[M(Q1,Q3)] of 63.0 (55.0, 69.0) years.The patients were divided into amputation group(n=344) and non-amputation group (n=93) according to whether toe-amputation surgery was performed within 3 months. The differences of clinical indicators between the two groups were analyzed.The patients were randomly divided into the training set and the validation set in a 7∶3 ratio using R 4.2. Multivariate logistic regression model was used to screen the influencing factors of toe-amputation in diabetic foot patients, and the nomogram of toe amputation prediction model was drawn. The predictive ability, accuracy and clinical applicability of the model were assessed using the area under the curve (AUC) of the receiver operating, calibration curve and decision curve analysis(DCA), respectively. Results: The patients in the toe amputation group had higher proportions of diabetes duration, lower extremity arterial disease (LEAD), white blood cell count, total bilirubin, fibrinogen, erythrocyte sedimentation rate, C-reactive protein level, and positive bacterial cultures in wound secretions compared to those in the non-toe amputation group. Conversely, the levels of high-density lipoprotein cholesterol, blood uric acid, the internal diameter and blood flow of dorsalis pedis artery were lower in the toe amputation group than those in the non-toe amputation group (all P<0.05). Multivariate logistic regression model analysis indicated that LEAD (OR=4.19,95%CI:1.88-9.34), blood uric acid (OR=0.99,95%CI:0.99-0.99), fibrinogen (OR=1.86,95%CI:1.19-2.91), and wound secretion culture positive for staphylococcus aureus (OR=5.77,95%CI:2.72-12.25) or non-staphylococcus aureus infection (OR=4.74,95%CI:1.43-15.77), were influencing factors of diabetic foot toe-amputations (all P<0.05). The prediction model of toe amputation in patients with diabetes foot was established using the above parameters. In the training set, the AUC, sensitivity and specificity of the prediction model for predicting toe amputation in diabetic foot patients were 0.86(95%CI:0.80-0.91)、90% and 72%, respectively. In the validation set, the AUC, sensitivity and specificity of the prediction model for predicting toe amputation in diabetic foot patients were 0.85(95%CI:0.78-0.92), 77% and 71%, respectively. The calibration curves of the training set and the validation set indicates that the model has good calibration ability. The DCA curve of the training set and the validation set suggests that the predictive model has good clinical applicability. Conclusions: LEAD, blood uric acid, fibrinogen, and positive bacterial culture of wound secretion are the influencing factors of diabetes toe amputation. The nomogram model including the above factors can evaluate the risk of diabetic foot amputation more intuitively.
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NewsBot · Jan 10, 2025

Predictive Factors of Amputation in Diabetic Foot
Francesco Farine et al
Biomedicines. 2024 Dec 6;12(12):2775.

Background: Diabetic foot ulcers are a common complication of diabetes mellitus, often leading to progressive sensory deficits, impaired vascularization, and a predisposition to ulceration and gangrene. Untreated ulcers may cause recurrent infections that endanger a patient's life. Amputation of part of the limb up to a well-vascularized level is one of the treatments employed for untreated ulcers. Objectives: Laboratory data were analyzed with the aim of identifying risk factors related to surgical amputation treatment of diabetic foot. We believe it is useful to identify risk factors that can be altered from a reversible condition in the clinical decision-making of treatment, thus manifesting themselves in a timely manner to provide the patient with an alternative to surgical amputation of the lower limb. Methods: Our retrospective study was conducted by the Department of Orthopedics and Traumatology at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome. We recruited 200 patients who underwent lower limb amputation for diabetic foot between 2017 and 2021 and had blood tests both 30 days and within 5 days before the first surgery. Results: This case-control study revealed a significant negative correlation between hemoglobin (Hb) levels and the occurrence of leg amputations. In contrast, C-reactive protein (CRP) levels, the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR) showed significant positive correlations with leg amputations. A 3-year follow-up of the cases also revealed a significative positive correlation between age, white blood cells (WBC) count, NLR, PLR, and death at 3 years. Conclusions: Our findings suggested that lower Hb levels and elevated CRP, NLR, and PLR levels in patients with diabetic foot disease may be associated with a higher risk of lower-limb amputation. Unexpectedly, this study also demonstrated that elderly age, WBC, CRP, NLR and PLR levels may be associated with a negative prognosis for these patients. These findings highlighted the importance of monitoring these laboratory values in diabetic patients to identify individuals at higher risk of leg amputations and implement appropriate interventions to prevent or minimize the occurrence of this severe complication.
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NewsBot · Jan 24, 2025

Age Characteristics of Patients With Type 2 Diabetic Foot Ulcers and Predictive Risk Factors for Lower Limb Amputation: A Population-Based Retrospective Study
Yuanying Yao et al
J Diabetes Res. 2024 Dec 19:2024:2380337.

Background: Limited data are available about the epidemiological characteristics and the risk factors for amputation, particularly in developing countries from Asia, especially in China. Objective: We aim to investigate the age features of patients with Type 2 diabetic foot ulcers (DFUs) and analyze the critical influencing factors predicting lower extremity amputation and major amputation. Methods: Data were retrieved from the electric medical record system to identify patients aged > 18 years with Type 2 DFU from January 1, 2017, to December 31, 2023. A logistic regression model was adopted to analyze the risk factors for amputation and major amputation. Results: Nine hundred eighteen patients with Type 2 DFU were eligible for our study, 68.2% of whom were male. In patients with Type 2 diabetes in the hospitals we studied, the prevalence of Type 2 DFU was 1.07%. A majority of patients with DFU were in the 70-79 age group in the winter season, and deaths also peaked in this age group. A total of 38.8% of patients aged 50-59 years underwent amputation. Vascular CTA, complications, history of amputation, and infection sites were the important contributing factors in patients with DFU lower extremity amputation. History of amputation and hemoglobin were the main influencing factors of patients with major amputation resulting from DFU. Conclusion: Most patients with DFU were in the age group of 50-59 years, but the majority of deaths occurred in the 70-79-year age group. Several factors influence the amputation, and those findings provide new insights into the relationship between the severity of narrowed blood vessels and the likelihood of amputation.
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NewsBot · Feb 16, 2025

Predictors of Major Lower Extremity Amputation in Type 2 Diabetic Patients With Diabetic Foot Ulcers: A Cross-Sectional Analytical Study
Neeraj Sharma et al
Cureus. 2025 Jan 12;17(1):e77339.

Introduction Diabetic foot ulcers (DFUs) are a significant complication of diabetes mellitus, often leading to major lower extremity amputation. Identifying predictive factors for amputation can guide interventions to prevent this severe outcome. This study aimed to identify predictors of major lower extremity amputation in type 2 diabetic patients with DFUs. Methodology A cross-sectional analytical study was conducted at the Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India, involving 101 patients with DFUs. The study assessed the association between various clinical and laboratory predictors and the necessity for major lower extremity amputation. Results Significant predictors for amputation included Wagner's grade ≥ 5, absent peripheral pulsation, clinical evidence of infection, and elevated levels of erythrocyte sedimentation rate and C-reactive protein. Conclusion This study highlights the importance of early identification of high-risk patients through detailed clinical assessment and laboratory investigations and underscores the need for aggressive management strategies targeting identified predictors to reduce the risk of major amputation among patients with DFUs.
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NewsBot · Apr 4, 2025

Assessment of Risk Factors Leading to Amputation Among Diabetic Septic Foot Patients in Khartoum, Sudan
Mohamed Elmubark et al
Cureus. 2024 Dec 11;16(12):e75517. doi: 10.7759/cureus.75517. eCollection 2024 Dec.

Introduction Diabetes is a rapidly growing global health concern, with the World Health Organization (WHO) estimating that 300 million adults will have diabetes by 2025. This chronic condition is associated with complications, including nephropathy, retinopathy, neuropathy, cardiovascular disease, and diabetic foot ulcers (DFUs), which can lead to amputation. Diabetic septic foot (DSF), a severe form of diabetic foot disease, is defined by the WHO as the presence of infection, ulceration, or tissue destruction in the lower limb, often accompanied by neurological abnormalities, peripheral vascular disease, and metabolic complications of diabetes. In Sudan, the incidence of lower limb amputations due to DSF is increasing, with various healthcare centers employing different management strategies, making it challenging to identify which factors are most strongly linked to the highest rates of amputations. This study aims to identify the key risk factors contributing to amputations in patients with diabetic foot syndrome (DFS) in Khartoum, Sudan. Specifically, it seeks to assess the common risk factors for amputation in diabetic septic foot patients at hospital wards and dressing centers in Khartoum State, Sudan. Objectives include identifying risk factors associated with amputations, determining the types and frequency of amputations, and evaluating diabetes control and foot self-care practices. Methods This was a descriptive cross-sectional study that was conducted anonymously between 01/11/2017 and 08/11/2017 in various hospital wards and dressing centers in Khartoum, Sudan, on 46 diabetic septic foot patients. Data was collected using an interview questionnaire and checklist administered to the attending patients. Quantitative data was analyzed using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. This paper aims to explore the pathophysiology, risk factors, and clinical management of diabetic foot complications, with a focus on preventing the devastating outcome of amputation. Results The findings revealed that the most significant risk factors for amputation included a raised HbA1c level (74%), male gender (78%), age over 50 years (96%), and a history of preceding non-healing ulcers (93.5%). Other factors, such as smoking, diabetes-related comorbidities, and the type of diabetes management, showed no significant association with amputation. Normal saline and iodine were the most commonly used wound care solutions (52%). Regarding foot care habits, the most frequently practiced measures among patients included wearing special diabetic shoes (63%), avoiding walking barefoot (63%), and refraining from smoking (59%). Conclusions This study identified key risk factors for amputations in diabetic septic foot (DSF) patients, including elevated HbA1C levels, male gender, age over 50, and a history of unhealing ulcers, with poor foot care practices contributing to higher amputation rates. The findings highlight the importance of glycemic control, foot hygiene, and patient education in preventing amputations. Additionally, the study underscores the need for comprehensive management strategies that address both metabolic control and foot care, particularly in resource-limited settings. These insights can guide local healthcare policies focused on prevention, early intervention, and better resource allocation to reduce diabetes-related complications and improve patient outcomes.
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NewsBot · May 27, 2025

Predictive factors of major amputation in patients with diabetic foot ulcers treated by peripheral blood mononuclear cells
Marco Meloni et al
Acta Diabetol. 2025 May 27.

Aim: Peripheral blood mononuclear cells (PB-MNCs) therapy is an adjuvant treatment for patients with ischaemic diabetic foot ulcers (DFUs) and no-option critical limb ischemia (NO-CLI). This study aimed to evaluate factors influencing the effectiveness of PB-MNC therapy.

Method: This prospective, not controlled study included a cohort of patients with DFUs and NO-CLI treated by PB-MNCs. NO-CLI was defined as the revascularization failure with desert foot (absence of any artery below-the-ankle) or partial desert foot (absence of a wound-related artery with TcPO2 < 30 mmHg) at the final post-procedural angiogram. After one year of follow-up, the rate of major amputation was evaluated such as clinical, wound, and vascular features of amputees in comparison to not amputees. In addition, the factors influencing the risk of major amputation were analyzed.

Results/discussion: Sixty-four patients were included. The mean age was 73.8 ± 5.8 years, 75% were male, and all of them had type 2 diabetes. At one year of follow-up, major amputation was documented in 12.5% of patients. Amputees had a higher rate of desert foot (vs. partial desert foot) (100% vs. 25%, p < 0.0001), higher post-procedural pain (5.7 ± 1.9 vs. 2.2 ± 1.3, p < 0.0001), lower TcPO2 after PB-MNCs therapy (30 ± 8 vs. 43 ± 8 mmHg, p = 0.0001), and more cases of heel ulcers (75% vs. 21.4%, p = 0.002). Independent predictors of major amputation resulted the presence of desert foot, persistence of post-procedural pain, heel involvement with multiple ulcers, and inability to stand or walk without assistance.

Conclusion: PB-MNCs therapy resulted less effective in patients with complete desert foot, persistence of paint after therapy, heel involvement in persons with multiple ulcers, and impaired walking.
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NewsBot · May 28, 2025

Creating a Practical Tool for Predicting Major Amputation Rate in Patients With Diabetic Hindfoot Ulcers: Focus on Ischemia and Infection
Ye-Won Choi et al
J Korean Med Sci. 2025 May 5;40(17):e55.

Background: Patients with diabetic hindfoot ulcers typically harbor significant concerns regarding their prospects for healing or the potential for major amputation. Nonetheless, a scarcity of data addressing this prevalent and critical query exists. Thus, the aim of this study was to create an initial risk-scoring system to forecast the prognosis of individuals with diabetic hindfoot ulcers, leveraging assessments of ischemia and infection severity, which are recognized as the principal risk factors for amputation.

Methods: Ischemia severity was categorized as iS0, iS1, or iS2 based on transcutaneous partial oxygen tension values, while infection severity was classified as iN0, iN1, or iN2 according to the results of tissue and bone biopsy cultures. Risk scores were determined by summing the scores for ischemia and infection severity, yielding a range of 0 to 4. Wound healing outcomes were graded as either healed with or without major amputation. Wound healing outcomes were assessed based on the assigned risk scores.

Results: With ascending risk scores, the proportion of patients subjected to major amputation also increased (P value for trend < 0.001). Univariable logistic regression analysis revealed a significant positive correlation between escalating risk scores and major amputation incidence. Patients with a risk score of 4 exhibited a 41-fold higher likelihood of undergoing major amputation compared to those with a risk score of 0.

Conclusion: Risk scores can serve as a reliable predictor of the major amputation rate in patients with diabetic hindfoot ulcers
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NewsBot · Jun 6, 2025

The Severity of Diabetes and the Risk of Diabetic Foot Amputation: A National Cohort Study
Jin Yu et al
Endocrinol Metab (Seoul). 2025 Apr 15

Background: This study aimed to assess whether markers of diabetes severity could serve as predictors for foot amputation risk among patients with type 2 diabetes mellitus.

Methods: We analyzed data from the nationally representative Korean National Health Insurance System database, tracking 2,544,077 patients with type 2 diabetes mellitus who participated in routine health check-ups between 2009 and 2012, with followup extending through the end of 2018. The parameters used to define the diabetes severity score encompassed diabetes duration, insulin usage, the number of oral glucose-lowering medications, the presence of chronic kidney disease, diabetic retinopathy, and cardiovascular disease. Each factor was assigned one point, yielding a cumulative severity score ranging from 0 to 6.

Results: The risk of diabetic foot amputation was predominantly predicted by insulin therapy, diabetic retinopathy, and a prolonged duration of diabetes. The hazard ratios for foot amputation increased with the severity score as follows: 2.31 (95% confidence interval [CI], 2.15 to 2.47) for a score of 1, 4.73 (95% CI, 4.42 to 5.07) for a score of 2, 8.86 (95% CI, 8.24 to 9.53) for a score of 3, 16.95 (95% CI, 15.60 to 18.4) for a score of 4, 23.98 (95% CI, 21.25 to 27.05) for a score of 5, and 37.87 (95% CI, 28.93 to 49.57) for a score of 6.

Conclusion: Specific markers of advanced diabetes effectively identified patients at an elevated risk for diabetic foot amputation.
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NewsBot · Jun 14, 2025

Predictive factors of major amputation in patients with diabetic foot ulcers treated by peripheral blood mononuclear cells
Marco Meloni, Ermanno Bellizzi, Luigi Uccioli, Laura Giurato, Valeria Ruotolo, Martina Salvi, Federico Rolando Bonanni, Aikaterini Andreadi, Alfonso Bellia & Davide Lauro
Acta Diabetologica

Aim

Peripheral blood mononuclear cells (PB-MNCs) therapy is an adjuvant treatment for patients with ischaemic diabetic foot ulcers (DFUs) and no-option critical limb ischemia (NO-CLI). This study aimed to evaluate factors influencing the effectiveness of PB-MNC therapy.
Method

This prospective, not controlled study included a cohort of patients with DFUs and NO-CLI treated by PB-MNCs. NO-CLI was defined as the revascularization failure with desert foot (absence of any artery below-the-ankle) or partial desert foot (absence of a wound-related artery with TcPO2 < 30 mmHg) at the final post-procedural angiogram. After one year of follow-up, the rate of major amputation was evaluated such as clinical, wound, and vascular features of amputees in comparison to not amputees. In addition, the factors influencing the risk of major amputation were analyzed.
Results/discussion

Sixty-four patients were included. The mean age was 73.8 ± 5.8 years, 75% were male, and all of them had type 2 diabetes. At one year of follow-up, major amputation was documented in 12.5% of patients. Amputees had a higher rate of desert foot (vs. partial desert foot) (100% vs. 25%, p < 0.0001), higher post-procedural pain (5.7 ± 1.9 vs. 2.2 ± 1.3, p < 0.0001), lower TcPO2 after PB-MNCs therapy (30 ± 8 vs. 43 ± 8 mmHg, p = 0.0001), and more cases of heel ulcers (75% vs. 21.4%, p = 0.002). Independent predictors of major amputation resulted the presence of desert foot, persistence of post-procedural pain, heel involvement with multiple ulcers, and inability to stand or walk without assistance.
Conclusion

PB-MNCs therapy resulted less effective in patients with complete desert foot, persistence of paint after therapy, heel involvement in persons with multiple ulcers, and impaired walking.
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NewsBot · Jun 17, 2025

Descriptive Analysis of Anatomical Location and Metabolic and Microbiological Factors in Diabetic Foot (DF) Treated at a DF Specialty Tertiary Care Hospital With a Multidisciplinary Approach
Amit R Burande et al
Cureus. 2025 Mar 16;17(3):e80690

Background and aims The outcome of a diabetic foot ulcer (DFU) may be affected by many factors, including the clinical anatomy of the ulcer, metabolic control, the presence of complications, and infections. This study evaluates the effect of metabolic factors, the clinical anatomy of the ulcer at presentation, and antibiotic appropriateness on treatment outcomes in terms of amputation in patients with diabetic foot (DF). Materials and methods This is a cross-sectional observational study involving data collected from patients with IPD diagnosed with type 2 diabetes mellitus and DFU at a tertiary care DF specialty hospital in Maharashtra, India. Results Data from a total of 106 patients were included for analysis. Fifty-two patients healed without amputation while 54 underwent either minor or major amputation. Patients who did not require amputation had a statistically significant higher incidence of cellulitis, ulcers at the heel and lateral malleolus, and ulcers classified as Wagner grade 1 or 2. In contrast, factors significantly associated with amputation included lower weight and BMI, multiple ulcers at presentation, ulcers involving the second, third, fourth, or fifth toe, midfoot, or medial malleolus, ulcers graded 3, 4, or 5, and additional surgery performed during the same hospital admission. The most commonly collected specimen was pus, followed by tissue and bone. The most frequently isolated microorganisms were Escherichia (E.) coli and Klebsiella. All microorganisms were sensitive to Piperacillin-Tazobactam and matched the initially prescribed antibiotic, which was chosen as per the hospital antibiogram. Angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin receptor blockers (ARBs) were prescribed more frequently in the non-amputation group while insulin use was higher in the amputation group, although there was no significant difference in the use of metabolic drugs between the two groups. Conclusion The anatomical location of the wound, advanced grade, number of ulcers, additional procedures, nutritional status, and the presence of Coagulase-negative Staphylococcus aureus in tissue are significant predictors of amputation.
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NewsBot · Jun 24, 2025 at 2:35 AM

Assessment of risk factors for amputation in patients with diabetic foot ulcers
Shivam Singh, Zulekha Bhimani, Mehnish Malik, Nidhi Shah and PS Eswar
Source

Introduction: Diabetes mellitus is a chronic metabolic disorder affecting millions worldwide, with diabetic foot ulcers (DFUs) being a devastating complication occurring in 15-25% of patients during their lifetime. Lower extremity amputation is a life-altering outcome in DFU patients, carrying a five-year mortality rate of up to 70%. This study aimed to comprehensively assess risk factors for amputation in patients with diabetic foot ulcers to develop more effective prevention strategies.
Methods: This ambispective study included 90 patients with diabetic foot ulcers from February 2023 to March 2025. Comprehensive clinical assessments included peripheral neuropathy testing, peripheral arterial disease evaluation through Ankle-Brachial Index (ABI), wound classification, and laboratory investigations including HbA1c. Risk factors assessed included glycemic control, peripheral vascular disease, neuropathy, infection, osteomyelitis, Charcot foot, gangrene, BMI, smoking status, and ulcer characteristics. Statistical analysis was performed using SPSS 20.0, with p<0.05 considered significant.
Results: Of 90 patients, 42% ultimately underwent amputation. Poor glycemic control (HbA1c >6.5%) was present in 95.2% of amputated patients versus 72.4% of non-amputated patients (p=0.07). Peripheral neuropathy was prevalent (66%), with no significant difference between groups. Ulcer healing status showed the strongest association with amputation (p<0.001), with 85.7% of amputated patients having non-healing ulcers compared to 37.9% in the non-amputated group. MRI evidence of osteomyelitis showed a significant association with amputation outcome (p=0.03). Neither smoking status (p=0.74) nor hypertension (p=0.917) showed statistically significant associations with amputation.
Conclusion: This study highlighted the multifactorial nature of amputation risk in DFU patients. Ulcer healing status emerged as the strongest predictor of amputation, while glycemic control showed a trending association. The results emphasize the importance of a comprehensive approach to DFU management, focusing on early detection, aggressive wound care, and tight glycemic control to reduce amputation rates in this vulnerable population.
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Risk factors for diabetes amputation

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Risk factors for diabetes amputation

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Risk Factors for Fractures and Falls in Older Women with Type 2 Diabetes

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Risk factors for ingrown toenails

Incidence and Risk Factors for Pin Site Infection of Exposed Kirschner Wires

The risk factors for diabetic peripheral neuropathy

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