INTRODUCTION: Diabetes Mellitus is associated with vascular disease. One of its macrovascular complications is peripheral arterial disease (PAD), which can present as critical limb ischemia (CLI) that can eventually lead to amputation and death.
OBJECTIVE: Determine the long-term outcome of Type 2 diabetic patients with critical limb ischemia in National Kidney and Transplant Institute (NKTI).
METHODS: Computerized search of NKTI Medical Records Section was done using the Docuview. Type 2 diabetic patients with critical limb ischemia of the lower extremities were included in the study. Patients were grouped according to the intervention received (No intervention, Bypass Graft or Peripheral Angioplasty). Endpoints such as amputation and mortality were ascertained on readmissions and on outpatient records. Data processing and analyses were performed using SPSS v20. Kaplan-Meier Survival Analysis was used to examine days to amputation and days to mortality between groups.
RESULTS: Twenty-three (23) patients were included in the study. There was no significant difference on the baseline characteristics of those who received revascularization and those who did not have revascularization. Amputation rate was 31% while mortality rate was 30% for the whole population. Patients who had revascularization seemed to have greater probability of amputation and lesser probability of dying, but these were not statistically significant based on Kaplan - Meier Survival Curves p values of 0.918 and 0.433, respectively.
CONCLUSION: Diabetic patients with CLI still carries a high risk of amputation and mortality even with revascularization but the time to amputation is longer for those who were revascularized.

Human ; Male ; Female ; Middle Aged ; Peripheral Arterial Disease ; Kaplan-meier Estimate ; Patient Readmission ; Amputation ; Lower Extremity ; Angioplasty ; Diabetes Mellitus, Type 2

Objectives: To determine the risk factors for recurrence and persistence of non-healing foot ulcers resulting in minor and major amputations. Methodology: This was an ambispective cohort analysis of persons with diabetic foot ulcers consulting at the diabetic foot clinic of East Avenue Medical Center. Data were analyzed through multiple logistic regression. Result: Two hundred sixteen patients with Type 2 Diabetes Mellitus and diabetic foot ulcers were included in the analysis; 50.9% were males and the mean age of the cohort was 55.8 ± 9.9 years. Outcomes of foot ulcers were: healed 44.5% (healed with no recurrence 30%, healed but with recurrence 14.5%) and not healed 55.5% (major amputation 11%, minor amputation, 21.5%, and persistently non-healing 23%). Multivariate logistic regression showed the following were independent risk factors for persistent non-healing ulcer: osteomyelitis (OR 66.5; CI 19.7, 217.8), smoking (OR 28.9; CI 6.8, 129.3, and peripheral arterial disease (PAD) (OR 56.8; CI 2.5, 877.2). Independent risk factors for ulcer recurrence were: plantar location of ulcer (OR 16.8; CI 6.8, 89.4), presence of more than one ulcer (OR 7.8; CI 3.6,31.6), and neuropathy (OR 11.2; CI 7.2, 19.9). For healed foot ulcers, mean healing time was 14 ± 3 weeks. Healing time was significantly reduced from 12 weeks to 4.5 weeks (p<0.001) if patients consulted earlier (within 4 weeks from sustaining an ulcer). Conclusion Only half (55%) of patients with diabetic foot ulcers consulting in a dedicated outpatient foot clinic had an adverse outcome of foot ulcers (major amputation 11%, minor amputation, 21.5%, and persistently non-healing ulcer 23%) while a small portion (14.5%) of patients had recurrent foot ulcers. Arterial obstruction, smoking, low hemoglobin, neuropathy, and osteomyelitis increase the likelihood of healing failure while the presence of multiple ulcers, plantar location of ulcers, and neuropathy increase the risk of ulcer recurrence.
Foot Ulcer ; Amputation, Surgical ; Peripheral Arterial Disease