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Diabetes Res Clin Pract. 2009 Jan;83(1):126-31. doi: 10.1016/j.diabres.2008.09.005. Epub 2008 Dec 20.

Mortality of first-time amputees in diabetics: a 10-year observation.

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WHO Collaborating Centre for Diabetes, National Hospital Organization Kyoto Medical Center, Fukakusa, Kyoto 612-8555, Japan.



We analyze mortality of first-time diabetic amputees by stratifying by level of amputation, differentiating short-term and long-term mortality.


We evaluated 277 diabetic patients who received their first lower extremity amputation (LEA) during 1993-97. Subjects were followed until December 2003, and categorized by level of amputation. We compared the mortality difference by level for 0-10 years, 0-10 months, and 10 months-10 years, and examined the association of comorbid conditions and death for each level.


We found a significant difference in mortality by amputation level for 0-10 years (p<0.05) and <10 months (p<0.01) survival, but not for the one of 10 months-10 years. For major amputees deceased within 10 months, sepsis was as frequent a cause of death as cardiovascular disease. In distal amputees, CVD, CAD and ESRD were strongly associated with death, but only CAD was associated death among major amputees.


For diabetic patients undergoing first LEAs, the mortality of major amputees was worse than that of minor amputees due to the difference in first 10-month mortality. The history of comorbid conditions in first-time major amputees was less important than in minor amputees since sepsis was the frequent cause of death in major amputees in this early period.

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