Diabetes-related lower-extremity amputation incidence and risk factors: a prospective seven-year study in Costa Rica Incidencia y factores de riesgo de la amputación de extremidades inferiores relacionada con la diabetes: estudio prospectivo de siete años en Costa Rica

• Main Authors: Adriana Laclé, Luis F. Valero-Juan
• Format: Article in Journal/Newspaper
• Language: English; Spanish; Portuguese
• Published: Pan American Health Organization 2012
• Subjects: Diabetes mellitus tipo 2; extremidad inferior; amputación; factores de riesgo; complicaciones de la diabetes; Costa Rica; Diabetes mellitus; type 2; lower extremity; amputation; risk factors; diabetes complications; Medicine; R; Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic; Bajos; Referencia
• Online Access: https://doaj.org/article/a21c609354134441a2057135b0371400

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. OBJETIVO: Analizar la incidencia y los determinantes de la amputación de extremidades inferiores (AEI) en personas diabéticas de una comunidad con bajos ingresos de Costa Rica. MÉTODOS: Se recopilaron datos sobre la incidencia de la AEI durante un período de seguimiento de siete años (del 2001 al 2007) en una cohorte de pacientes diabéticos (n = 572). Se analizaron los factores de riesgo usando el modelo de regresión de Cox de riesgos proporcionales y los valores de referencia del año 2000 de las variables (características sociodemográficas, comorbilidad, control metabólico, tratamiento y complicaciones microvasculares crónicas). RESULTADOS: La incidencia de la AEI fue de 6,02 por 1 000 personas-año (8,65 en varones y 4,50 en mujeres). Los factores de riesgo conocidos (sexo, años de evolución de la diabetes, ...