[PHNUTR-L] Taller Diabetics at Greater Risk for Amputation

[Kathrynne Holden, MS, RD]

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Taller Diabetics at Greater Risk for Amputation
http://www.medpagetoday.com/Endocrinology/Diabetes/dh/2585

	By Michael Smith , MedPage Today Staff Writer
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, 
University of California, San Francisco

	
		
	MedPage Today Action Points

     * Advise diabetic patients that this study suggests that taller 
diabetic patients are more likely to require a lower-extremity 
amputation at some point that those who are shorter.

     * Note that this implies great attention should be paid to 
peripheral sensory loss and that leg ulcers should be monitored and 
treated carefully.

	
	Review
TAIPEI, Taiwan, Jan. 31 - Taller diabetic patients are more likely to 
require a lower-limb amputation, a researcher here says.

Height is an independent predictor of lower-extremity amputation, 
according to a study carried out by Chin-Hsiao Tseng, M.D., Ph.D., of 
the National Taiwan University Hospital here.

The implication is that taller patients should be monitored closely for 
peripheral sensory loss and leg ulcers, Dr. Tseng reported in the Jan. 
31 issue of the Canadian Medical Association Journal.

In Taiwan, Dr. Tseng noted, diabetes accounts for between a third and 
half of all lower-limb amputations, but the rates are lower in Taiwan 
than they are among Caucasian populations, who are on average taller.

To evaluate the potential link between height and amputations, between 
1995 and 2002, trained interviewers telephoned 128,572 diabetic 
patients, randomly selected from 256,036 patients who had been seen in 
the country's hospitals and clinics between 1995 and 1998.

Of those, 93,484 agreed to be interviewed. There were 42,970 men and 
50,146 women included in the study (386 who were younger than 18 years 
were excluded), Dr. Tseng reported.

Analysis of the responses showed:

     * 3,259, or 3.5%, had type 1 diabetes.
     * Lower-extremity amputation was performed in 1.7% of type 1 
patients and 0.8% of type 2 patients. The difference was significant, 
with an odds ratio of 1.67 and a 95% confidence interval from 1.24 to 2.25.
     * Among those with type 1 diabetes, there was no significant 
difference between men and women.
     * Among those with type 2 diabetes, 0.9% of men had an amputation, 
compared with 0.7% of women. The result was significant at p<0.01.
     * Every 10-cm increment in height was significantly associated with 
an increased risk of amputation. The odds ratio, adjusted for age, sex, 
smoking status, length of diabetes, hypertension, and type of disease, 
was 1.16, with a 95% confidence interval from 1.03 to 1.32.

Dr. Tseng identified a subgroup of 9,295 patients for whom data on 
fasting plasma glucose levels and dyslipidemia were available. In that 
group, after additional adjustment for those variables:

     * Height remained an independent predictor of lower-extremity 
amputation; the adjusted odds ratio for every 10 centimeters of height 
was 1.79, with a 95% confidence interval from 1.14 to 2.82.
     * Type of disease lost significance.
     * Dyslipidemia was not a significant predictor, but fasting plasma 
glucose was; the adjusted odds ratio was 1.12 for every increment of 
0.6-mmol/L, with a 95% confidence interval from 1.04 to 1.21.

Because of its design, Dr Tseng said, the study had several limitations, 
including the inability to evaluate sensory dysfunction; the effect of 
height would have been underestimated if taller patients were less 
healthy in the first place.

Also, the length of study may have produced a health survivor bias: "If 
taller patients undergoing lower-extremity amputation are at lower risk 
of death than shorter patients undergoing such amputation, estimates of 
the effects of height on amputation might be overestimated," he said.

Nonetheless, he concluded, height seems is a risk factor for amputation 
that appears to be independent of other known risk factors.
Primary source: Canadian Medical Association Journal
Source reference:
Chin-Hsiao Tseng. Prevalence of lower-extremity amputation among 
patients with diabetes mellitus: Is height a factor? CMAJ 2006:174(3). 
DOI:10.1503/cmaj.050680.
-- 
Kathrynne Holden, MS, RD < fivestar at nutritionucanlivewith.com >
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