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2. Risk factors for lower limb complications in diabetic patients. The Italian Study Group for the Implementation of the St. Vincent Declaration.

Author

el-Shazly M, Abdel-Fattah M, Scorpiglione N, Benedetti MM, Capani F, Carinci F, Carta Q, Cavaliere D, De Feo EM, Taboga C, Tognoni G, and Nicolucci A

Subjects
Adult, Age Factors, Aged, Cardiovascular Diseases complications, Case-Control Studies, Cerebrovascular Disorders complications, Diabetic Foot epidemiology, Diabetic Neuropathies complications, Female, Humans, Insulin therapeutic use, Italy epidemiology, Life Style, Male, Marital Status, Middle Aged, Odds Ratio, Patient Education as Topic, Quality of Health Care, Risk Factors, Sex Factors, Diabetes Mellitus, Type 1 complications, Diabetes Mellitus, Type 2 complications, Diabetic Foot etiology, Diabetic Foot prevention & control
Abstract

Diabetic lower extremity complications may be influenced by a number of factors, including those related to the interaction between patients and the health-care system. Our objective is to identify risk factors for the development of lower limb complications, by looking for classical clinical variables and those related to quality of care. A case-control study was carried out between December 1993 and June 1994 by interviewing 348 patients with lower-limb diabetic complications and 1050 controls enrolled from 35 diabetes outpatient clinics and 49 general practitioner's offices in Italy. Among sociodemographic characteristics associated with increased risk of lower limb complications were male gender [odds ratio (OR) = 2.5, confidence interval (CI) 1.6-3.9], age between 50 and 70 years as opposed to younger than 50 (OR = 3.6, CI 2.1-6.3) and being single as opposed to married (OR = 1.4, CI 1.1-1.8). Among clinical variables, treatment with insulin for IDDM and NIDDM patients was an important predictor of lower extremity complications compared to NIDDM patients not being treated with insulin. Cardio-cerebrovascular disease and presence of diabetic neuropathy were associated with a higher risk of being a case (OR = 1.4, CI 1.2-1.8 and OR = 3.0, CI 2.1-4.2, respectively). Patients who needed help to reach the health facility before the onset of the complications and those who did not attend health facilities regularly were more liable to develop complications (OR = 1.5, CI 1.1-2.2 and OR = 2.0, CI 1.3-3.0, respectively). Patients who had never received educational intervention had a threefold risk of being a case as compared to those who received health information regularly. The study identifies factors most likely to be related to adverse outcome and permits to discriminate between avoidable and unavoidable factors.

Published
1998
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3. Diabetes-related lower extremity amputations in the community: a study based on hospital discharge diagnoses

Author

olga vaccaro, Lodato S, Mariniello P, De Feo E, Vaccaro, Olga, S., Lodato, P., Mariniello, and ME De, F. e. o.

Subjects
Adult, Male, Incidence, Length of Stay, Middle Aged, Amputation, Surgical, Diabetic Foot, Patient Discharge, Survival Rate, Age Distribution, Treatment Outcome, Italy, Lower Extremity, Reference Values, Case-Control Studies, Humans, Female, Registries, Sex Distribution, Diabetic Angiopathies, Aged, Follow-Up Studies, Probability
Abstract

To assess the validity of hospital discharge diagnoses (HDDs) as a means for the surveillance of diabetes-related lower extremity amputations on a population basis, and to compare the demographic and clinical characteristics of diabetic and non-diabetic amputees.All of the 1996 hospital discharge diagnoses reporting ICD-9-CM codes 84.10-84.19 were reviewed in the Campania Region, an area in Southern Italy with 5.7 million inhabitants. Diabetes was defined as any concomitant 250 ICD-9 code. The completeness of ascertainment and accuracy in reporting diabetes were validated in a sub-sample of cases by matching their HDDs with the register of buried limbs and the clinical records of the hospital. During the study period, 701 individuals underwent 738 amputations, 330 (47.1%) of whom had diabetes mentioned in their discharge diagnosis. All of the amputations reported in the buried limbs register were identified by the HDDs, whereas some minor amputations recorded in the HDDs were not reported in the registers. On the basis of the clinical charts, the diagnosis of diabetes was underreported by 10%. The proportion of females was significantly higher among the diabetic amputees (41% vs 35%), whereas the proportion of people aged less than 50 years was significantly lower (5% vs 13%) (p0.002). The duration of hospitalisation was similar for the diabetics and non-diabetics (23 +/- 20 vs 22 +/- 18 days). Minor amputations were significantly more frequent in the individuals with diabetes (38.8% vs 29.1%; p0.001), as was reamputation (7.2% vs 2.9%; p0.01).These findings confirm the markedly increased risk of amputation among diabetics and demonstrate that HDDs represent a suitable procedure for the surveillance of lower extremity amputations.

Published
2002

4. A controlled study of the use of autologous platelet gel for the treatment of diabetic foot ulcers

Author

G. Saldalamacchia, V. Cuomo, E. Lapice, ME De Feo, E. D’Agostino, RIVELLESE, ANGELA ALBAROSA, RICCARDI, GABRIELE, VACCARO, OLGA, Saldalamacchia, G., Lapice, E., Cuomo, V., De Feo, E., D'Agostino, Elio, Rivellese, ANGELA ALBAROSA, Vaccaro, O., G., Saldalamacchia, V., Cuomo, E., Lapice, ME De, Feo, E., D’Agostino, Riccardi, Gabriele, and Vaccaro, Olga

Subjects
medicine.medical_specialty, Nutrition and Dietetics, business.industry, Endocrinology, Diabetes and Metabolism, medicine, Medicine (miscellaneous), Autologous platelet, Cardiology and Cardiovascular Medicine, medicine.disease, Diabetic ulcers, business, Diabetic foot, Surgery
Published
2004

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