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. 2017 Apr 4;16(1):41.
doi: 10.1186/s12933-017-0524-8.

Impact of diabetes on outcome in critical limb ischemia with tissue loss: a large-scaled routine data analysis

Eva Freisinger  1 , Nasser M Malyar  2 , Holger Reinecke  2 , Holger Lawall  3
Affiliations

Impact of diabetes on outcome in critical limb ischemia with tissue loss: a large-scaled routine data analysis

Eva Freisinger et al. Cardiovasc Diabetol. .

Abstract

Background: Patients with diabetes concomitant to critical limb ischemia (CLI) represent a sub-group at particular risk. Objective of this analysis is to evaluate the actual impact of diabetes on treatment, outcome, and costs in a real-world scenario in Germany.

Methods: We obtained routine-data on 15,332 patients with CLI with tissue loss from the largest German health insurance, BARMER GEK from 2009 to 2011, including a follow-up until 2013. Patient data were analyzed regarding co-diagnosis with diabetes with respect to risk profiles, treatment strategy, in-hospital and long-term outcome including costs.

Results: Diabetic patients received less overall revascularizations in Rutherford grades 5 and 6 (Rutherford grade 5: 45.0 vs. 55.5%; Rutherford grade 6: 46.5 vs. 51.8; p < 0.001) and less vascular surgery (Rutherford grade 5: 13.4 vs. 23.4; Rutherford grade 6: 19.7 vs. 29.6; p < 0.001), however more often endovascular revascularization in Rutherford grade 6 (31.0 vs. 28.1; p = 0.004) compared to non-diabetic patients. Diabetes was associated with a higher observed ratio of infections (35.3 vs. 23.5% Rutherford grade 5; 44.3 vs. 27.4% Rutherford grade 6; p < 0.001) and in-hospital amputations (13.0 vs. 7.3% Rutherford grade 5; 47.5 vs. 36.7% Ruth6; p < 0.001). Diabetes further increased the risk for amputation during follow-up [Rutherford grade 5: HR 1.51 (1.38-1.67); Rutherford grade 6: HR 1.33 (1.25-1.41); p < 0.001], but not for death.

Conclusions: Diabetes increases markedly the risk of amputation attended by higher costs in CLI patients with tissue loss (OR 1.67 at Rutherford 5, OR 1.53 at Rutherford 6; p < 0.001), but is associated with lower revascularizations. However, in Rutherford grades 5 and 6, concomitant diabetes does not further worsen the overall poor survival.

Keywords: Critical limb ischemia; Diabetes; Epidemiology; Outcome; Routine-data analysis.

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Figures

Fig. 1
Fig. 1
Treatment procedures related to diabetes status at Rutherford grade 5 and 6. Treatment procedures for angiography, overall revascularization (any revasc), endovascular revascularization (EVR), surgery (surg), thrombendartherectomy (TEA), and peripheral bypass in patients at Rutherford grade 5 (a) and Rutherford grade 6 (b) are given as percentages among patient sub-groups with diabetes (DM; orange bars) and without (grey bars). Differences between DM and non-DM sub-groups are considered significant for p values <0.05
Fig. 2
Fig. 2
Cox regression analysis of amputations and long-term mortality related to Rutherford grade and diabetes status. a – d show Cox regression analyses for the end-points amputation and mortality during the 4-year follow-up period within Rutherford grade 5 and Rutherford grade 6. Amputation rate is significantly higher in patients with diabetes (DM; continuous line) compared to non-DM patients (dashed line) in Rutherford grade 5 (a) and Rutherford grade 6 (b). Mortality does not significantly differ between DM and non-DM patients in Rutherford grade 5 (c) and is slightly lower in DM compared to non-DM patients in Rutherford grade 6 (d). p values <0.05 are regarded significant
See this image and copyright information in PMC

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