Diabetes mellitus is assumed to negatively affect the outcomes of critical limb ischemia (CLI). To determine the implications of diabetes in a population of patients with infrapopliteal CLI, a team of researchers compared clinical outcomes in patients with and without diabetes, as well as the rates of major amputation (above ankle level) and major events (major amputation or death) between CLI patients with and without diabetes. Hazard ratios (HRs) were calculated.
Of a total of 281 patients with CLI, diabetes was present in 49.1 percent. The major amputation rate at five years of follow-up was higher in patients with diabetes than in patients without diabetes (34.1 percent versus 20.4 percent, P = 0.015). The major event and death rate did not differ. The unadjusted HR of diabetes for the major amputation risk was 1.87 (95 percent CI 1.12-3.12). Model factors with significant HRs in the multivariate analysis were baseline Rutherford category (HR 1.95; 95% CI 1.24-3.06) and ankle-brachial index (ABI) >1.4 (HR 2.78; 95% CI 1.37-5.64).
Given these results, the researchers conclude that patients with both CLI and diabetes are at a significantly higher risk of major amputation than patients with CLI but without diabetes. This increased risk is associated with a higher prevalence of baseline ABI >1.4 and more severe ischemia at initial presentation in patients with diabetes.
The study was published in September’s issue of Diabetes Care.
