(HealthDay News) — Patients with diabetes and a lower extremity amputation are more likely to die, with some of the increased risk due to diabetes-related complications, according to a study published in Diabetes Care.

Ole Hoffstad, from the University of Pennsylvania Perelman School of Medicine in Philadelphia, and colleagues conducted a longitudinal cohort study involving patients cared for in the Health Improvement Network.

The researchers estimated the impact of lower extremity amputation on death, examining the impact of risk factor variables such as history of cardiovascular disease (CVD), Charlson index and history of chronic kidney disease.

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After a lower extremity amputation, the hazard ratio for death was 3.02, the researchers found. After adjustment for all risk factor variables, the hazard ratio was attenuated by about 22% — to 2.37. Lower extremity amputation had an area under the receiver operating curve (AUC) of 0.51, which was poorly predictive of death; after full adjustment, the AUC was slightly better — 0.77.

“Individuals with diabetes and a [lower extremity amputation] are more likely to die at any given point in time than those who have diabetes but no [lower extremity amputation],” the researchers wrote. “While some of this variation can be explained by known complications of diabetes, there remains a large amount of unexplained variation.”


  1. Hoffstad O et al. Diabetes Care. 2015;doi:10.2337/dc15-0536.