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Diabetes Management and Its Association with Transtibial Amputation

Kun Yan Department of Physical Medicine and Rehabilitation, Tufts University School of Medicine, Boston, MA.

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Terri K. Pogoda Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA; Department of Health Policy and Management, Boston University School of Public Health, Boston, MA.

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Background

Transtibial (TTA) and transfemoral (TFA) amputations are rarely considered as distinct events when examining major lower-limb amputation outcomes. The objective of this study was to investigate the relationships among type 2 diabetes, diabetes management strategies, hemoglobin A1c levels, and other health factors related to TTA and TFA.

Methods

The retrospective medical record review included abstracting demographic and health-related data from the electronic medical records of 92 patients who received amputation-related services in a Department of Veterans Affairs hospital.

Results

Patients who controlled their diabetes with insulin (with or without other oral agents) were significantly more likely to undergo TTA (adjusted odds ratio [aOR] = 7.63; 95% confidence interval [CI], 1.17–49.97; P = .03) compared with patients who controlled their diabetes through noninsulin medications or by diet. Patients who underwent no previous surgery (aOR = 6.66; 95% CI, 0.89-49.72; P = .06) or partial amputation only (aOR = 15.44; 95% CI, 1.04–228.29; P = .05) compared with a combination of partial amputation and bypass, thrombolectomy, or stent procedures were marginally to statistically significantly more likely to undergo TTA than TFA.

Conclusions

The preferential association between TTA with insulin-dependent diabetes and higher hemoglobin A1c levels versus TFA with previous lower-limb bypasses, stent placement, and thrombolytic interventions distinguishes TTA and TFA as two distinct entities, and awareness of this difference may help clinicians design preventive strategies accordingly.

The opinions expressed in this article are the authors' and do not reflect those of the Department of Veterans Affairs, Harvard Medical School, Tufts University School of Medicine, or Boston University School of Public Health.

Corresponding author: Terri K. Pogoda, PhD, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S Huntington Ave (152M), Boston, MA 02130. (E-mail: terri.pogoda@va.gov)