Significance of glycosylated haemoglobin determination for the assessment of lower-extremity amputation risk in patients with diabetic foot

Abstract

Glycosylated hemoglobin (HbA1c) is important parameter for the assessment of long term metabolic control and risk for development of chronic complications in patients with diabetes mellitus (DM). This study investigates associations between achieved metabolic control in type 2 DM with the risk for the development of diabetic foot (DF) and its treatment modalities. The study included 111 patients (80 men and 31 women) with type 2 DM, aged 65.5±9.8 years. In 41 patients DF was treated by a conservative approach, 41 patients underwent a minor limb amputation (foot amputation) and 29 patients underwent a major limb amputation (below-knee amputation). The levels of HbA1c and serum biochemical parameters were measured by standard laboratory methods. The most frequent risk factor for DF in the examined group (82% patients) was poor glycaemic control (HbA1c>8%). The level of HbA1c was significantly higher in surgically treated patients than in the conservatively treated group (P<0.05). The number of patients who underwent surgical treatment were significantly higher in the group with poor glycaemic control (62.8% patients with poor glycaemic control vs. 40% patients with optimal glycaemic control; P<0.05). We found that the patients with poor glycaemic control had 3.2 times higher risk for amputation (OR=3.21; 95%CI:1.18-8.69; P<0.05). In conclusion, our results demonstrated that optimal metabolic control in type 2 DM reduces the risk for DF development, as well as the invasiveness of DF treatment.

Keywords

• diabetes mellitus
• metabolic control
• chronic complications
• hba1c