Factors associated with amputation in people with foot ulcers as a consequence of Diabetes Mellitus
DOI:
https://doi.org/10.12957/reuerj.2025.93874Keywords:
Diabetes Mellitus, Foot Ulcers, Diabetes Complications, Surgical Amputation, NursingAbstract
Objective: to analyze the factors associated with amputation in people with foot ulcers as a consequence of Diabetes Mellitus. Methods: a cross-sectional and analytical study conducted with 132 individuals with Diabetes Mellitus hospitalized in an Emergency hospital. The data were collected by means of interviews and by checking medical records. The data analysis was performed using the following statistical tests: Pearson's chi-square, Fisher's exact, Mann-Whitney's U and binary logistic regression. Results: in the bivariate analysis, dry skin and/or cracks, onychocryptosis, interdigital maceration, callouses and cold, cyanotic and pale feet were associated with amputation (p<0.05). In the multivariate model, the female gender was a protective factor against amputation (p=0.049). The individuals with peripheral neuropathy were 34.98 times more likely to suffer amputations (p=0,005); in turn, having a previous amputation history increased the amputation chances by 869.8 times (p<0.001). Conclusion: amputation was associated with foot complications, biological sex, peripheral neuropathy and previous amputations.
References
1. McDermott K, Fang M, Boulton AJM, Selvin E, Hicks CW. Etiology, epidemiology, and disparities in the burden of diabetic foot ulcers. Diabetes Care. 2023 [cited 2025 Aug 20]; 46(1):209–21. DOI: https://doi.org/10.2337/dci22-0043.
2. Edmonds M, Manu C, Vas P. Diabetic foot ulcers: a review of current management. Diabet Med. 2023 [cited 2025 Aug 20]; 40(6):e15084. DOI: https://doi.org/10.1001/jama.2023.10578.
3. International Working Group on the Diabetic Foot. IWGDF guideline on the prevention of foot ulcers in persons with diabetes. Brussels: IWGDF; 2019 [cited 2025 Aug 20]. Available from: https://iwgdfguidelines.org/wp-content/uploads/2019/05/IWGDF-Guideline-on-the-prevention-of-foot-ulcers-in-persons-with-diabetes.pdf.
4. Agência Brasil. Diabetes behind 28 amputations in Brazil every day [Site de Internet]. 2023 [cited 2025 Aug 29]. Available from: https://agenciabrasil.ebc.com.br/en/saude/noticia/2023-11/diabetes-behind-28-amputations-brazil-every-day.
5. Frykberg RG, Banks J. Challenges in the treatment of chronic wounds. Adv Wound Care (New Rochelle). 2022 [cited 2025 Aug 20]; 11(12):659-70. DOI: https://doi.org/10.1089/wound.2015.0635.
6. Santos ICRV, Carvalho EF, Souza WV, Albuquerque EC. Factors associated with diabetic foot amputations. J Vasc Bras. 2022 [cited 2025 Aug 20]; 21:e20210049. DOI: http://dx.doi.org/10.1590/1677-5449.20140049.
7. Bus SA, Armstrong DG, van Netten JJ. The role of footwear and offloading interventions in preventing and healing foot ulcers in diabetes. Endocrinol Metab Clin North Am. 2023 [cited 2025 Aug 20]; 52(3):477-93. DOI: http://dx.doi.org/10.1007/978-3-319-89869-8_27.
8. World Health Organization. Sustainable Development Goals. Genebra: World Health Organization; 2017 [cited 2025 Aug 20]. Available from: https://www.who.int/europe/news-room/questions-and-answers/item/sustainable-development-goals.
9. Ministério da Saúde (Br). Estratégias para o cuidado da pessoa com doença crônica: diabetes mellitus. Brasília (DF): Ministério da Saúde; 2019 [cited 2025 Jun 16]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/estrategias_cuidado_pessoa_diabetes_mellitus_cab36.pdf.
10. Mello RFA, Pires MLE, Kede J. Ficha de avaliação clínica de membros inferiores para prevenção do pé diabético. Rev. Pesqui. (Univ. Fed. Estado Rio J., Online). 2017 [cited 2025 Aug 20]; 9(3):899–913. DOI: https://doi.org/10.9789/2175-5361.2017.v9i3.899-913.
11. Secretaria Municipal Da Saúde De Ribeirão Preto. Roteiro para rastreamento do pé diabético na atenção primária. Ribeirão Preto: Coordenadoria de Atenção às Pessoas com Doenças Crônicas não Transmissíveis; 2023 [cited 2025 Aug 26]. Available from: https://www.ribeiraopreto.sp.gov.br/portal/pdf/saude669202302.pdf.
12. Ministério da Saúde (Br). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Diretrizes de atenção à pessoa amputada. 1. ed. Brasília: Ministério da Saúde, 2013 [cited 2025 Jan 12]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_atencao_pessoa_amputada.pdf.
13. Katz MH. Multivariable analysis: a primer for readers of medical research. Ann Intern Med. 2003 [cited 2025 Aug 20]; 138(8):644-50. DOI: https://doi.org/10.7326/0003-4819-138-8-200304150-00012.
14. Garson GD. Structural equation modeling. Asheboro: Statistical Publishing Associates; 2010.
15. Iacopi E, Pieruzzi L, Riitano N, Abbruzzese L, Goretti C, Piaggesi A. The weakness of the strong sex: differences between men and women affected by diabetic foot disease. Int J Low Extrem Wounds. 2021 [cited 2025 Aug 20]; 22(1):9-26. DOI: https://doi.org/10.1177/1534734620984604.
16. Bus AS, Sacco ICN, Monteiro-Soares M, Raspovic A, Paton J, Rasmussen A, et al. Guidelines on the prevention of foot ulcers in persons with diabetes. The International Working Group on the Diabetic Foot. IWGDF Guidelines, 2023 [cited 2025 Aug 20]. DOI: https://doi.org/10.1002/dmrr.3651.
17. International Working Group on the Diabetic Foot. IWGDF guidelines on prevention and management of diabetic foot disease 2023 update. Brussels: IWGDF; 2023 [cited 2025 Aug 20]. Available from: https://iwgdfguidelines.org/wp-content/uploads/2023/07/IWGDF-Guidelines-2023.pdf.
18. Neves RG, Tomasi E, Duro SMS, Saes-Silva E, Saes MO. Complications due to diabetes mellitus in Brazil: 2019 nationwide study, 2019. Cien Saude Colet. 2023 [cited 2025 Aug 20]; 28(11):3183-90. DOI: https://doi.org/10.1590/1413-812320232811.11882022.
19. Bus SA, Armstrong DG, Crews RT, Gooday C, Jarl G, Kirketerp-Moller K. Guidelines on offloading foot ulcers in persons with diabetes. The International Working Group on the Diabetic Foot. IWGDF Guidelines, 2023 [cited 2025 Aug 20]. DOI: https://doi.org/10.1002/dmrr.3647.
20. Zhang Y, Liu H, Yang Y, Feng C, Cui L. Incidence and risk factors for amputation in Chinese patients with diabetic foot ulcers: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2024 [cited 2025 Aug 20]; 30(15):1405301. DOI: https://doi.org/10.3389/fendo.2024.1405301.
21. Rayna T, Flores M, Quiñonez E, Mendoza JA, Corzo VF, Ortiz C, et al. Factors associated with major lower extremity amputations in diabetic foot infections at a county hospital in Guatemala. J Surg Res. 2024 [cited 2025 Aug 20]; 302:100-5. DOI: https://doi.org/10.1016/j.jss.2024.07.033.
22. Vuorlaakso M, Kiiski J, Salonen T, Karppelin M, Helminen M, Kaartinen I. Major amputation profoundly increases mortality in patients with diabetic foot infection. Front Surg. 2021 [cited 2025 Aug 20]; 30(8):655902. DOI: https://doi.org/10.3389/fsurg.2021.655902.
23. Mansoor Z, Modaweb A. Predicting amputation in patients with diabetic foot ulcers: a systematic review. Cureus. 2022 [cited 2025 Aug 20]; 14(7):e27245. DOI: https://doi.org/10.3389/fsurg.2021.655902.
24. Lira JAC, Nogueira LT, Oliveira BMA, Soares DR, Santos AMR, Araújo TME. Factors associated with the risk of diabetic foot in patients with diabetes mellitus in Primary Care. Rev Esc Enferm USP. 2021 [cited 2025 Aug 20]; 55:e03757. DOI: https://doi.org/10.1590/S1980-220X2020019503757.
25. Godoy JMP, Mazzocchi JC, Westin LG, Monteiro LB, Silva GL, Lopes TAS. Evolução após amputação de dedo do pé relacionada ao pé diabético. Mundo Saúde (Online). 2024 [cited 2025 Aug 29]; 48:e16402024. DOI: https://doi.org/10.15343/0104-7809.202448e16402024P.
26. International Working Group on the Diabetic Foot. Guidelines on the prevention of foot ulcers in persons with diabetes 2023 update. Diabetes Metab Res Rev. 2023 [cited 2025 Aug 20]; ePublished. DOI: https://doi.org/10.1002/dmrr.3651.
27. Lira JAC, Oliveira BMA, Soares DR, Benício CDAV, Nogueira LT. Risk evaluation of feet ulceration in people with diabetes mellitus in primary care. REME: Rev Min Enferm. 2020 [cited 2025 Aug 20]; 24:e1327. DOI: http://dx.doi.org/10.5935/1415-2762.20200064.
28. Singh S, Bhimani Z, Malik M, Shah N, Eswar PS. Assessment of risk factors for amputation in patients with diabetic foot ulcers. Int J Diabetes Res. 2025 [cited 2025 Aug 20]; 7(1):18–22. DOI: https://doi.org/10.33545/26648822.2025.v7.i1a.21.
29. Farine F, Rapisarda AM, Roani C, Giuli C, Comisi C, Mascio A, et al. Predictive factors of amputation in diabetic foot. Biomedicines. 2024 [cited 2025 Aug 20]; 12(12):2775. DOI: https://doi.org/10.3390/biomedicines12122775.
30. Lira JAC, Rocha ASC, Bezerra SMG, Nogueira PC, Santos AMR, Nogueira LT. Effects of educational technologies on the prevention and treatment of diabetic ulcers: A systematic review and meta-analysis. Rev. Latino-Am. Enfermagem. 2023 [cited 2025 Aug 20]; 31:e3945. DOI: https://doi.org/10.1590/1518-8345.6628.3945.
31. Bus SA, Armstrong DG, van Netten JJ, et al. IWGDF guidelines on the prevention of foot ulcers in persons with diabetes: 2023 update. Diabetes Metab Res Rev. 2024 [cited 2025 Aug 20]; 40(1):e3746. DOI:https://doi.org/10.1002/dmrr.3746.
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Álvaro Sepúlveda Carvalho Rocha, Lídya Tolstenko Nogueira, Jefferson Abraão Caetano Lira, Sandra Marina Gonçalves Bezerra, Ana Maria Ribeiro dos Santos, Claudia Daniella Avelino Vasconcelos
This work is licensed under a Creative Commons Attribution 4.0 International License.
When publishing in Revista Enfermagem UERJ, the authors declare that the work is their exclusive authorship and therefore assume full responsibility for its content.
Authors retain copyright to their article and agree to license their work using a Creative Commons Attribution International Public License (CC BY), thereby accepting the terms and conditions of this license (https://creativecommons.org/licenses/by/4.0/legalcode.en), which allows material created by the author to be distributed, copied and displayed by third parties. The original work must be cited and present a link to the article available on the website of the journal in which it was published.
The Copyright of the articles published in Revista Enfermagem UERJ belongs to their respective author(s), with the rights of first publication assigned to Revista Enfermagem UERJ, with the work simultaneously licensed under a Creative Commons License CC BY, which allows sharing of work with recognition of authorship and initial publication in this journal.
The authors grant Revista Enfermagem UERJ the right of first publication, to identify themselves as the original publisher of the work and grant the magazine a license of non-exclusive rights to use the work in the following ways:
- Sell and/or distribute the work in printed copies and/or electronic format;
- Distribute parts and/or the work as a whole with the aim of promoting the magazine through the internet and other digital and printed media;
- Record and playback work in any format, including digital media.
In line with the journal's policies, each published article will be assigned a Creative Commons Attribution (CC BY) license.
