scholarly journals Foot Ulcer and Risk of Lower Limb Amputation or Death in People With Diabetes: A National Population-Based Retrospective Cohort Study

Diabetes Care ◽  
2021 ◽  
pp. dc211596
Author(s):  
Rosemary C. Chamberlain ◽  
Kelly Fleetwood ◽  
Sarah H. Wild ◽  
Helen M. Colhoun ◽  
Robert S. Lindsay ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Lower Limb ◽  
Retrospective Cohort ◽  
Foot Ulcer ◽  
Population Based ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
National Population

scholarly journals Predicting successful prosthetic rehabilitation in major lower-limb amputation patients: a 15-year retrospective cohort study

2018 ◽  
Vol 22 (3) ◽  
pp. 205-214 ◽  
Author(s):  
Inés Fajardo-Martos ◽  
Olga Roda ◽  
Ramón Zambudio-Periago ◽  
Aurora Bueno-Cavanillas ◽  
Fidel Hita-Contreras ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Lower Limb ◽  
Retrospective Cohort ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Prosthetic Rehabilitation

scholarly journals Associations between attainment of incentivized primary care indicators and incident lower limb amputation among those with type 2 diabetes: a population-based historical cohort study

2021 ◽  
Vol 9 (1) ◽  
pp. e002069
Author(s):  
Laura H Gunn ◽  
Eszter P Vamos ◽  
Azeem Majeed ◽  
Pasha Normahani ◽  
Usman Jaffer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Cohort Study ◽  
Lower Limb ◽  
Population Based ◽  
Lower Limb Amputation ◽  
Medical Decision ◽  
Limb Amputation

IntroductionEngland has invested considerably in diabetes care through such programs as the Quality and Outcomes Framework (QOF) and National Diabetes Audit (NDA). Associations between program indicators and clinical endpoints, such as amputation, remain unclear. We examined associations between primary care indicators and incident lower limb amputation.Research design and methodsThis population-based retrospective cohort study, spanning 2010–2017, was comprised of adults in England with type 2 diabetes and no history of lower limb amputation. Exposures at baseline (2010–2011) were attainment of QOF glycated hemoglobin (HbA1c), blood pressure and total cholesterol indicators, and number of NDA processes completed. Propensity score matching was performed and multivariable Cox proportional hazards models, adjusting for disease-related, comorbidity, lifestyle, and sociodemographic factors, were fitted using matched samples for each exposure.Results83 688 individuals from 330 English primary care practices were included. Mean follow-up was 3.9 (SD 2.0) years, and 521 (0.6%) minor or major amputations were observed (1.62 per 1000 person-years). HbA1c and cholesterol indicator attainment were associated with considerably lower risks of minor or major amputation (adjusted HRs; 95% CIs) 0.61 (0.49 to 0.74; p<0.0001) and 0.67 (0.53 to 0.86; p=0.0017), respectively). No evidence of association between blood pressure indicator attainment and amputation was observed (adjusted HR 0.88 (0.73 to 1.06; p=0.1891)). Substantially lower amputation rates were observed among those completing a greater number of NDA care processes (adjusted HRs 0.45 (0.24 to 0.83; p=0.0106), 0.67 (0.47 to 0.97; p=0.0319), and 0.38 (0.20 to 0.70; p=0.0022) for comparisons of 4–6 vs 0–3, 7–9 vs 0–3, and 7–9 vs 4–6 processes, respectively). Results for major-only amputations were similar for HbA1c and blood pressure, though cholesterol indicator attainment was non-significant.ConclusionsComprehensive primary care-based secondary prevention may offer considerable protection against diabetes-related amputation. This has important implications for diabetes management and medical decision-making for patients, as well as type 2 diabetes quality improvement programs.

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