Type of publication:
Conference abstract
Author(s):
*Basavaraju N.; *Al-Samaraaie E.; *Cane C.; *Beard N.; *Moulik P.
Citation:
Diabetic Medicine. Conference: Diabetes UK Professional Conference 2024. London . 41(Supplement 1) (no pagination), 2024. Date of Publication: 01 Apr 2024
Abstract:
Aims: Shropshire and Telford have significantly higher minor and major non-traumatic diabetic lower-limb amputations. We analysed data on risk factors leading to major amputation. Method(s): Data on all 48 major non-traumatic lower-limb amputation in diabetes between April 2022 and March 2023 were analysed. Result(s): 90% type 2 diabetes with 32 (67%) diabetes duration >10 years, 11 (23%) <10 years, 1 was diagnosed at admission. 17 (35%) were female. 38 (80%) were between 50 and 80, 9 (18%) over 80 years age. 26 (54%) had below knee and 22 (46%) above knee amputation. Postcode-based assessment of deprivation indices revealed amputations were higher in patients from most deprived (29%) compared to deprived (25%), average (21%), affluent (20%) and very affluent (4%) areas. 20 (41%) were considered concordant, 18 (37%) non-concordant by the assessing clinician. 21 (42%) were overweight or obese. Half were current or ex-smokers, 58% hypertensive, 79% hyperlipidaemic or on statins, 83% on antiplatelet/anticoagulants. Sixteen (44%) had eGFR >60 mL/min, 17 (35%) 30-60 mL/min, 4 (8%) eGFR 15-30mL/min and none with eGFR <15mL/min. HbA1c was <48 mmol/mol in 10%, 48-68 mmol/mol in 35%, 69-99 mmol/mol in 37% and >100 mmol/mol in 17%. 37% had pre-proliferative/proliferative retinopathy or maculopathy. 80% had high risk feet, 28 (58%) previous foot ulcers and 19 (40%) previous amputation. 80% had neuropathy and peripheral arterial disease and 10% had Charcot. Final cause of amputation was critical ischaemia in 27 (56%), infection/osteomyelitis/sepsis in 7 (15%), spreading gangrene in 10 (21%) and Charcot in 4 (8%). Conclusion(s): Long-standing diabetes with multiple chronic complications and social deprivation were associated with major amputations. Cardiovascular risk factors were generally well managed. Preventive strategies must focus on improving metabolic and risk factor management early in disease.
DOI: 10.1111/dme.15295
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