Prevalence and factors associated with lower limb amputation in individuals with type II diabetes mellitus in a referral hospital in Fortaleza, Ceará, Brazil: A hospital-based cross-sectional study

Abstract

Aims: To analyze the association between demographic, socioeconomic, clinical, epidemiological, and primary healthcare factors with the severity of lower limb amputations (LLAs) in individuals with type II diabetes mellitus (DM-II) at a reference hospital in Fortaleza, Ceará, in Northeast Brazil. Methods: A cross-sectional study was performed with a representative sample of individuals hospitalized with DM-II and the degree of LLA severity: (1) toes; (2) transmetatarsal or infrapatellar; (3) suprapatellar; (4) disarticulation or bilateral. Potentially associated factors with the outcome degree of amputation severity were identified in a semi-structured evaluation during hospitalization. The prevalence ratios of the degree of amputation severity as a function of associated factors were calculated with robust variance Poisson regression models. Results: The prevalence of high degree of severity in amputations (suprapatellar, with disarticulation or bilateral) was high in the total sample of 385 patients, revealing to be 49% (187/385). Prevalence ratios (PR) indicated a higher prevalence of DM-II amputation severity in patients who lacked of specific guidance on DM-II amputation in primary care (PR = 1.52, 95% CI: 1.05–2.21). Conclusions: LLAs in DM-II were associated with age above 67 years, male gender, cardiovascular disease, and low support for guidance at the primary healthcare level.

Keywords

• Diabetes
• Insulin
• Epidemiology
• Public health
• Quality of life
• Disability