Diabetes mellitus: a risk factor for severity of critical atherosclerotic ischemic disease and for lower limb viability

Abstract

Objective: to characterize diabetes mellitus as an independent risk factor for the severity of critical lower limb ischemia and for viability of affected limbs.

Context and type of study: Hospital based census on registers of all surgical patients for revascularization or major amputation by atherosclerotic critical ischemia or lower limbs from 1st January, 2005 until 30th June, 2009. Units of analysis were clinical records of patients who met the study's admission criteria.

Material and methods: univariate and bivariate descriptions depending on type and distribution of variables. Detection of confounders and modifiers of effects of the association between diabetes and severity of critical ischemia, and diabetes and intervention, by stratification in the analysis.

Results: adjusted for the positive confounding effect of hypertension, odds of diabetes mellitus in patients with ischemic disease Fontaine IV was 8.23 to patients with Fontaine III (X2MH 1df 13.18; p value = 0.0003). Controlled for the positive confounding effect of chronic renal failure, odds of diabetes mellitus in patients with Fontaine IV was 7.99 to patients with Fontaine III (X2MH 1df 12.00; p value = 0.0005). Controlled for the severity of critical lower limb ischemia, patients with diabetes mellitus had a possibility of primary major amputation 6.32 in relation to non-diabetic patients primary amputation (X2MH 1df 8.455; p value = 0.0036).

Conclusion: Diabetes mellitus is an independent risk factor for the development of the most severe state of critical ischemia of the lower limbs, Fontaine IV, after adjusting for hypertension and chronic renal failure. Also, diabetes became an independent risk factor for the viability of the limb with critical ischemia