scholarly journals The relationship of regional hemoglobin A1c testing and amputation rate among patients with diabetes

Vascular ◽  
2016 ◽  
Vol 25 (2) ◽  
pp. 142-148
Author(s):  
Karina A Newhall ◽  
Kimon Bekelis ◽  
Bjoern D Suckow ◽  
Daniel J Gottlieb ◽  
Adrienne E Farber ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Hemoglobin A1c ◽  
Lower Extremity Amputation ◽  
Amputation Rate ◽  
The Past ◽  
Hospital Referral ◽  
Patients With Diabetes ◽  
Leg Amputation ◽  
The Relationship ◽  
Extremity Amputation

Objective The risk of leg amputation among patients with diabetes has declined over the past decade, while use of preventative measures—such as hemoglobin A1c monitoring—has increased. However, the relationship between hemoglobin A1c testing and amputation risk remains unclear. Methods We examined annual rates of hemoglobin A1c testing and major leg amputation among Medicare patients with diabetes from 2003 to 2012 across 306 hospital referral regions. We created linear regression models to study associations between hemoglobin A1c testing and lower extremity amputation. Results From 2003 to 2012, the proportion of patients who received hemoglobin A1c testing increased 10% (74% to 84%), while their rate of lower extremity amputation decreased 50% (430 to 232/100,000 beneficiaries). Regional hemoglobin A1c testing weakly correlated with crude amputation rate in both years (2003 R = −0.20, 2012 R = −0.21), and further weakened with adjustment for age, sex, and disability status (2003 R = −0.11, 2012 R = −0.17). In a multivariable model of 2012 amputation rates, hemoglobin A1c testing was not a significant predictor. Conclusion Lower extremity amputation among patients with diabetes nearly halved over the past decade but only weakly correlated with hemoglobin A1c testing throughout the study period. Better metrics are needed to understand the relationship between preventative care and amputation.

scholarly journals HbA1c and Lower-Extremity Amputation Risk in Low-Income Patients With Diabetes

Diabetes Care ◽  
2013 ◽  
Vol 36 (11) ◽  
pp. 3591-3598 ◽  
Author(s):  
W. Zhao ◽  
P. T. Katzmarzyk ◽  
R. Horswell ◽  
Y. Wang ◽  
J. Johnson ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Low Income ◽  
Lower Extremity Amputation ◽  
Patients With Diabetes ◽  
Extremity Amputation

scholarly journals Geographic and Socioeconomic Disparities in Major Lower Extremity Amputation Rates in Metropolitan Areas

2021 ◽  
Vol 10 (17) ◽  
Author(s):  
Alexander C. Fanaroff ◽  
Lin Yang ◽  
Ashwin S. Nathan ◽  
Sameed Ahmed M. Khatana ◽  
Howard Julien ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Lower Extremity ◽  
Metropolitan Areas ◽  
Major Amputation ◽  
Lower Extremity Amputation ◽  
Amputation Rate ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Zip Code ◽  
Extremity Amputation

Background Rates of major lower extremity amputation in patients with peripheral artery disease are higher in rural communities with markers of low socioeconomic status, but most Americans live in metropolitan areas. Whether amputation rates vary within US metropolitan areas is unclear, as are characteristics of high amputation rate urban communities. Methods and Results We estimated rates of major lower extremity amputation per 100 000 Medicare beneficiaries between 2010 and 2018 at the ZIP code level among ZIP codes with ≥100 beneficiaries. We described demographic characteristics of high and low amputation ZIP codes, and the association between major amputation rate and 3 ZIP code–level markers of socioeconomic status—the proportion of patients with dual eligibility for Medicaid, median household income, and Distressed Communities Index score—for metropolitan, micropolitan, and rural ZIP code cohorts. Between 2010 and 2018, 188 995 Medicare fee‐for‐service patients living in 31 391 ZIP codes with ≥100 beneficiaries had a major lower extremity amputation. The median (interquartile range) ZIP code–level number of amputations per 100 000 beneficiaries was 262 (75–469). Though nonmetropolitan ZIP codes had higher rates of major amputation than metropolitan areas, 78.2% of patients undergoing major amputation lived in metropolitan areas. Compared with ZIP codes with lower amputation rates, top quartile amputation rate ZIP codes had a greater proportion of Black residents (4.4% versus 17.5%, P <0.001). In metropolitan areas, after adjusting for clinical comorbidities and demographics, every $10 000 lower median household income was associated with a 4.4% (95% CI, 3.9–4.8) higher amputation rate, and a 10‐point higher Distressed Communities Index score was associated with a 3.8% (95% CI, 3.4%–4.2%) higher amputation rate; there was no association between the proportion of patients eligible for Medicaid and amputation rate. These findings were comparable to the associations identified across all ZIP codes. Conclusions In metropolitan areas, where most individuals undergoing lower extremity amputation live, markers of lower socioeconomic status and Black race were associated with higher rates of major lower extremity amputation. Development of community‐based tools for peripheral artery disease diagnosis and management targeted to communities with high amputation rates in urban areas may help reduce inequities in peripheral artery disease outcomes.

scholarly journals NON –TRAUMATIC LOWER EXTREMITY AMPUTATIONS IN DIABETICS

2012 ◽  
Vol 19 (05) ◽  
pp. 615-619
Author(s):  
Muhammad ATEEQ ◽  
ABID BASHIR ◽  
SHAZIA JEHAN
Keyword(s):  
Lower Extremity ◽  
Teaching Hospital ◽  
Care Service ◽  
Health Care Service ◽  
Lower Extremity Amputation ◽  
Amputation Rate ◽  
Diabetic Patients ◽  
Foot Care ◽  
Cross Sectional ◽  
Extremity Amputation

Objective: The purpose of this study was to estimate the prevalence of non -traumatic lower extremity amputations in diabetic inperipheral teaching hospital catchment area. Study Design: Prospective, Cross sectional, Interventional. Setting: Surgical Unit II. Aziz BhattiShaheed (Teaching) Hospital. Nawaz Sharif medical College, University of the Gujrat. Study Period: February 1, 2011 to January 31, 2012.Results: A total of 132 patient were subjected to non traumatic lower extremity amputation were enrolled in this study out of which 89 (67.42%)were diabetic, followed by non specific infections n=39 (23.48) Out of 89 total diabetic patients 53 (40.15%) patients were female whereas 36(27.27%) were male. Both major and minor non traumatic lower extremity amputation rate was more in female diabetic patients than malediabetics. Conclusions: The prevalence of non –traumatic below knee amputations at an early age is high in our diabetic patients, especially infemale population. By improving primary health care service regarding foot care awareness in diabetics appears to be the main way to reducethe amputation rate.

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