Thailand Diabetes Registry Project: Prevalence and Risk Factors Associated with Lower Extremity Amputation in Thai Diabetics
Sirinate Krittiyawong MD*, Chardpraorn Ngarmukos MD**, Yupin Benjasuratwong MD***, Petch Rawdaree MD****, Rattana Leelawatana MD*****, Natapong Kosachunhanun MD******, Nattachet Plengvidhya MD*******, Chaicharn Deerochanawong MD********, Sompongse Suwanwalaikorn MD*********, Thongchai Pratipanawatr MD**********, Thanya Chetthakul MD***********, Sirima Mongkolsomlit BSc************, Pongamorn Bunnag MD**
Affiliation : * Theptarin General Hospital, ** Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University *** Department of Internal Medicine, Phramongkutklao Hospital, **** BMA Medical Collage and Vajira Hospital ***** Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla ****** Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai ******* Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University ******** Rajavithi Hospital, ********* Department of Medicine, Faculty of Medicine, Chulalongkorn University ********** Deptpartment of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen *********** Department of Medicine, Maharaj NakhornRatchasima, Hospital, Nakhorn Ratchasima ************ TDR research coordinator
Objective : To determine the prevalence and risk factors associated with lower extremity amputation (LEA) in
Thai diabetics.
Materials and Methods : A cross-sectional, multicenter, hospital-based diabetes registry was carried out from
April to December 2003. Baseline characteristics and risk factors were analysed from 9,419 diabetic patients.
peripheral vascular disease (PVD) was defined as absent or diminished dorsalis pedis (DP) and posterior
tibialis (PT) pulses to palpation in the same limb. LEA was defined as surgical removal of part of a lower
extremity.
Results : The prevalence of LEA was 1.5% (142). Mean diabetes duration was 10 years (SD = 7.6). Out of 556
patients with a history of foot ulcer, 123 (22.1%) underwent amputation. PVD was present in 370 patients.
Most of LEAs were toe amputations (64.1%). Multiple logistic regression analysis of risk factors (adjusted OR,
[95% confidence interval], p value) revealed a high risk of LEA in patients with a history of ulcer (59.2, [32.8-
106.8], p < 0.001), peripheral vascular disease (5.3, [3.1-9.2], p < 0.001), diabetic retinopathy (2.2, [1.3-
3.8], p = 0.004), and insulin injection (1.9, [1.1-3.2], p < 0.023).
Conclusion : Patients at risk for LEA were those with a history of foot ulcer, absence of peripheral pulse,
diabetic retinopathy and insulin injection. Preventive strategies should be considered in these groups of
patients. Data should be interpreted with caution as the number of patients with amputation was few and
information on neuropathy was not available.
Keywords : Lower extremity amputation, Revascularization, Semmes-Weinstein monofilament
