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OBJECTIVE - To determine the mortality rate after diabetes-related lower-extremity amputation (LEA) in an African-descent Caribbean population.
RESEARCH DESIGN AND METHODS - We conducted a prospective case-control study. We recruited case subjects (with diabetes and LEA) and age-matched control subjects (with diabetes and no LEA) between 1999 and 2001. We followed these groups for 5 years to assess mortality risk and causes.
RESULTS - There were 205 amputations (123 minor and 82 major). The 1-year and 5-year survival rates were 69 and 44% among case subjects and 97 and 82% among control subjects (case-control difference, P < 0.001). The mortality rates (per 1,000 person-years) were 273.9 (95% CI 207.1-362.3) after a major amputation, 113.4 (85.2-150.9) after a minor amputation, and 36.4 (25.6-51.8) among control subjects. Sepsis and cardiac disease were the most common causes of death.
CONCLUSIONS - These mortality rates are the highest reported worldwide. Interventions to limit sepsis and complications from cardiac disease offer a huge potential for improving post-LEA survival in this vulnerable group.
Diabetes Care 32:306-307, 2009
The diabetic foot syndrome, including lower-extremity amputation (LEA), is a major contributor to morbidity and mortality from diabetes in developed countries (1). There are limited outcome data from the developing world (2). High incidence of type 2 diabetes is reported in the Caribbean (3), and the incidence of diabetes-related LEA in Barbados ranks among the highest reported in the world (4).
RESEARCH DESIGN AND METHODS - The Barbados studies of amputation among people with diabetes proceeded in three stages. An initial amputation incidence study recruited participants undergoing LEA in the 12month period starting in November 1999. We defined an amputation as mi- nor if it involved the toes or foot and as major if it was through the tibia or femur. We further divided major amputations into below-the-knee amputations (BKAs) or above-the-knee amputations (AKAs). We then recruited one randomly selected population-based control group for every case to initiate a case-control study of risk factors for diabetes-related LEA. Control subjects had diabetes, had never had an amputation, and were age matched in 5-year age-groups. We restricted analyses to participants who reported their race as black (205 case and 194 control subjects). A detailed description of methods, along with LEA incidence and risk factors, has...