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- Title
Medical strategies to reduce amputation in patients with Type 2 diabetes.
- Authors
Malik, R. A.; Tesfaye, S.; Ziegler, D.
- Abstract
Lower extremity amputation is a common and disabling complication of Type 2 diabetes. Whilst the introduction of specialist multidisciplinary teams has led to a reduction in the incidence of lower extremity amputation in some centres, the overall prevalence of diabetes-related amputation has actually increased in recent decades. The aetiology of diabetes-related amputation is complex, with neuropathy, macrovascular and microvascular disease contributing significantly. Ulceration, previous amputation, increasing diabetes duration and poor long-term control of glycaemia and lipids are important risk factors for amputation in populations with diabetes. Major randomized intervention trials of blood glucose-lowering or anti-hypertensive therapies in populations with diabetes have shown limited reductions in neuropathy and/or macrovascular disease, and no benefit on amputation rates. In contrast, a recent analysis from the Fenofibrate Intervention and Event Lowering in Diabetes ( FIELD) study showed a significantly reduced rate of minor, but not major amputations in patients with Type 2 diabetes treated with fenofibrate. Mechanistic studies are clearly needed to understand the basis of this benefit.
- Subjects
UNITED States; EVALUATION of clinical trials; PERIPHERAL neuropathy diagnosis; ULCER diagnosis; DIABETIC foot prevention; TYPE 2 diabetes complications; AMPUTATION; DATABASES; PEOPLE with diabetes; FENOFIBRATE; HEALTH care teams; HIGH density lipoproteins; LEG; MEDICAL practice; TYPE 2 diabetes; DIABETIC foot; DISEASE complications; THERAPEUTICS
- Publication
Diabetic Medicine, 2013, Vol 30, Issue 8, p893
- ISSN
0742-3071
- Publication type
Article
- DOI
10.1111/dme.12169