Amputation among patients with diabetes mellitus - increased risk of neuropathy and diabetic ulcers

Patients with diabetes mellitus are at risk of leg ulcers. These eventually become infected, respond poorly to treatment and often require amputation of the foot or part of the leg.

Several factors combine to increase the chances of a leg ulcer developing. One of these is the loss of nerve conduction to the lower extremity so that patient's don't feel symptoms of a developing ulcer (pain) and don't recognize its early presence. It is also known that such neuropathy (declining nerve function) occurs most frequently and earliest in longer nerves, such as those going to the legs.

In this study, the authors looked at rates of amputation among close to 100 000 patients with diabetes mellitus and found that height was a strong predictor of amputation.

In the whole study population, every 10-cm increase in height was associated with a 16% increase in risk of amputation. In the subgroup of patients for whom data on fasting plasma glucose levels and dyslipidemia were available, the risk of amputation was even greater (79% relative increase in risk of amputation. This finding was independent of other factors such as the adequacy of diabetes control.

These findings, particularly that the risk of amputation was present even among patients who had good control of their diabetes and other risk factors, should prompt clinicians and patients to be alert to the increased risk of neuropathy and diabetic ulcers in taller patients.

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