Revista Panamericana de Salud Pública
On-line version ISSN 1680-5348
Print version ISSN 1020-4989
LACLE, Adriana and VALERO-JUAN, Luis F.. Diabetes-related lower-extremity amputation incidence and risk factors: a prospective seven-year study in Costa Rica. Rev Panam Salud Publica [online]. 2012, vol.32, n.3, pp.192-198. ISSN 1680-5348. http://dx.doi.org/10.1590/S1020-49892012000900004.
OBJECTIVE: To analyze the incidence and determinants of lower-extremity amputation (LEA) in people with diabetes in a low-income community in Costa Rica. METHODS: Data on LEA incidence were collected during a seven-year follow-up (2001-2007) in a diabetes patient cohort (n = 572). Risk factors were analyzed using the Cox proportional hazards regression model and baseline variables from the year 2000 (socio- demographic characteristics, comorbidity, metabolic control, treatment, and chronic microvascular complications). RESULTS: LEA incidence was 6.02 per 1 000 person-years (8.65 in men and 4.50 in women). Known risk factors (sex, years of diabetes, elevated glycated hemoglobin [HbA1c], retinopathy, insulin therapy, and prior amputation) were highly significant. CONCLUSIONS: Those most likely to undergo LEA among Costa Rican diabetic patients were men with 10 or more years of diabetes and average HbA1c > 8% who used insulin and had diabetic retinopathy. Patients on insulin therapy were at greatest risk, especially those with a previous amputation. Diabetic patients with the above-mentioned profile should be considered to be at very high risk of LEA and followed closely by the health care system.
Keywords : Diabetes mellitus, type 2; lower extremity; amputation; risk factors; diabetes complications; Costa Rica.