Li et al reported a score for predicting lower extremity amputation in a type 2 diabetic. This can help to identify a patient who may benefit from more aggressive management. The authors are from China Medical University and Asia University in Taichung, Taiwan.
Patient selection: type 2 diabetic, from 30 to 84 years of age
Parameters:
(1) age in years
(2) sex
(3) duration of type 2 diabetes
(4) body mass index (BMI) in kg per square meter
(5) hemoglobin A1c in percent
(6) serum triglycerides in mg/dL
(7) eGFR in mL per min per 1.73 square meters
(8) percent variation in fasting blood glucose
(9) stroke
(10) diabetic retinopathy
(11) hypoglycemia
(12) foot ulcer
(13) anti-diabetes medications
(14) diuretic therapy
(15) nitrates
|
Parameter |
Finding |
Points |
|
age in years |
30 to 34 years |
-2 |
|
|
35 to 39 years |
-1 |
|
|
40 to 44 years |
0 |
|
|
45 to 49 years |
1 |
|
|
50 to 54 years |
2 |
|
|
55 to 59 years |
3 |
|
|
60 to 64 years |
4 |
|
|
65 to 69 years |
5 |
|
|
70 to 74 years |
6 |
|
|
75 to 79 years |
7 |
|
|
80 to 84 years |
8 |
|
sex |
female |
0 |
|
|
male |
4 |
|
duration of diabetes |
< 1 year |
0 |
|
|
1 to 5 years |
9 |
|
|
> 5 years |
13 |
|
BMI |
< 25 |
4 |
|
|
25 to 29.99 |
0 |
|
|
>= 30 |
3 |
|
hemoglobin A1c |
< 7% |
0 |
|
|
>= 7% |
5 |
|
serum triglycerides |
< 150 mg/dL |
0 |
|
|
>= 150 mg/dL |
3 |
|
eGFR |
>= 60 mL/min/1.73 sq m |
0 |
|
|
< 60 |
7 |
|
fasting blood glucose variation |
< 17.6% |
0 |
|
|
17.6 to 34.9% |
1 |
|
|
>= 35% |
4 |
|
stroke |
no |
0 |
|
|
yes |
6 |
|
diabetic retinopathy |
no |
0 |
|
|
yes |
4 |
|
hypoglycemia |
no |
0 |
|
|
yes |
5 |
|
foot ulcer |
no |
0 |
|
|
yes |
10 |
|
anti-diabetic medication |
none |
0 |
|
|
oral only |
1 |
|
|
insulin |
9 |
|
|
oral and insulin |
8 |
|
diuretics |
no |
0 |
|
|
yes |
3 |
|
nitrates |
no |
0 |
|
|
yes |
6 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -2
• maximum score: 91
|
Total Score |
Amputation Risk |
OR Amputation |
|
< 24 |
low |
1 |
|
24 to 32 |
medium |
3.9 |
|
> 32 |
high |
11.4 |
Performance:
• The area under the ROC curve for various endpoints and cohorts ranged from 0.74 to 0.81.
Specialty: Surgery, orthopedic
