Type 2 Diabetes

Tissue loss is a major predictor of amputation in diabetes and peripheral arterial disease

Posted on

The presence and severity of tissue loss are the most significant predictors of amputation risk in patients with diabetes and peripheral arterial disease (DM/PAD), surpassing other demographic and socioeconomic factors, according to a study.

Researchers analyzed Medicare claims data spanning from 2007 to 2019, focusing on patients with continuous fee-for-service coverage diagnosed with DM/PAD. Using ICD-9 and ICD-10 codes, they categorized patients into 8 tissue loss groups, ranging from lymphadenitis (least severe) to gangrene (most severe). A Cox proportional hazards model was employed to assess the 1- and 5-year amputation risks associated with each tissue loss category, adjusting for demographic, socioeconomic, and preventive factors.

The study included 12,257,174 patients, with 48% male and 76% White. Among them, 10% had a history of myocardial infarction, and 30% had chronic kidney disease. While 82% of patients had no tissue loss, 18% (2.2 million) experienced some form of tissue loss. The 1-year amputation rate for patients with tissue loss was 6.4%, compared to 0.4% for those without tissue loss.

One-year amputation rates varied significantly by tissue loss severity:

  • Lymphadenitis: 0.89%
  • Gangrene: 26%

The risk of amputation increased dramatically with the severity of tissue loss:

  • Lymphadenitis: Adjusted Hazard Ratios 1.96
  • Gangrene: Adjusted Hazard Ratios 28.7

No other demographic variables, including age, sex, race, or region, showed a hazard ratio for amputation risk higher than that of the least severe tissue loss category. Higher rates of DM/PAD were inversely correlated with risk-adjusted 5-year amputation rates (R² = 0.43).

The study concluded that tissue loss is the most significant predictor of amputation in patients with DM/PAD, with its impact surpassing other factors such as age, sex, race, and region. The findings suggest that tissue loss should be a key focus in patient management and public health campaigns.

Ponukumati AS, Krafcik BM, Newton L, et al. Association between tissue loss type and amputation risk among Medicare patients with concomitant diabetes and peripheral arterial disease. J Vasc Surg. 2024;S0741-5214(24)01279-5. doi: 10.1016/j.jvs.2024.06.019. Epub ahead of print. PMID: 38880181.