The Prevalence of Amputation in Regional Asia due to Diabetic Foot Ulcers 2024: A Systematic Review and Meta-analysis
DOI:
https://doi.org/10.61716/jnj.v2i3.64Keywords:
amputation, diabetic foot ulcer, asia, systematic review-meta-analysisAbstract
Background: Over the past decade, the prevalence of diabetic foot ulcers (DFUs) has notably increased, posing a significant risk of foot amputation in individuals with diabetes. Purpose: This systematic review and meta-analysis aimed to determine the rates of amputation associated with DFUs in patients with diabetes mellitus. Methods: A comprehensive literature search was conducted across multiple databases, including Scopus, PubMed, Cochrane, Web of Science, DOAJ, and Google Scholar. Full-text articles related to diabetic foot ulcer amputation were reviewed and extracted for analysis. Publication Bias: Assessed using a funnel plot in Jamovi (2.0.0), indicating a likelihood of publication bias. Meta-analysis Summary: Conducted using the Joanna Briggs Institute methodology, yielding a pooled meta-analysis result of 0.027. Odds Ratio (OR): Calculated for amputation risk in DFU patients, with a 95% Confidence Interval (CI). Random Effects Model: Employed to synthesize relevant outcomes. Heterogeneity: Evaluated using the I² statistic. Forest Plots: Generated to visualize study results. Results: Eighteen studies were included in the meta-analysis, encompassing a total of 7115 DFU patients in the Asian region. Among these patients, 2730 underwent foot amputations. Amputation Rate: The incidence of foot amputation was significantly higher among DFU patients. Pooled Odds Ratio: The OR for foot amputation in DFU patients was 0.34 (95% CI: 0.23-0.46). Publication Bias: The asymmetrical funnel plot suggested a high likelihood of publication bias. Conclusion: The presence of DFUs significantly elevates the risk of foot amputation in diabetic patients. Continuous monitoring and preventive strategies are essential to mitigate this risk, particularly in the Asian population.
References
1. Sapra A, Bhandari P. Diabetes Mellitus [Internet]. StatPearls Publishing, Treasure Island (FL); 2022. 34 p. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551501/
2. Jiang P, Li Q, Luo Y, Luo F, Che Q, Lu Z, et al. Current status and progress in research on dressing management for diabetic foot ulcer. Front Endocrinol. 2023 Aug 17;14:1221705.
3. Netten JJ van, Bus SA, Apelqvist J, Chen P, Chuter V, Fitridge R, et al. Definitions and criteria for diabetes related foot disease(IWGDF 2023 update). Willey. 2023;40(3):1–7.
4. Packer CF, Awab S. Diabetic Ulcer [Internet]. UK: StatPearls Publishing LLC.; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499887/
5. Brussels. International Diabetes Federation. The Diabetic Foot [Internet]. Belgium; 2020. Available from: https://www.idf.org/our-activities/care-prevention/diabetic-foot.html
6. Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. Ingelfinger JR, editor. N Engl J Med. 2017 Jun 15;376(24):2367–75.
7. Hoffstad O, Mitra N, Walsh J, Margolis DJ. Diabetes, Lower-Extremity Amputation, and Death. Diabetes Care. 2015 Oct 1;38(10):1852–7.
8. Meloni M, Izzo V, Giurato L, Lázaro-Martínez JL, Uccioli L. Prevalence, Clinical Aspects and Outcomes in a Large Cohort of Persons with Diabetic Foot Disease: Comparison between Neuropathic and Ischemic Ulcers. J Clin Med. 2020 Jun 8;9(6):1780.
9. McDermott K, Fang M, Boulton AJM, Selvin E, Hicks CW. Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care. 2023 Jan 2;46(1):209–21.
10. Rathnayake A, Saboo A, Malabu UH, Falhammar H. Lower extremity amputations and long-term outcomes in diabetic foot ulcers: A systematic review. World J Diabetes. 2020 Sep 15;11(9):391–9.
11. Gasoyan H, Hussain SR, Wright WG, Sarwer DB. Disparities In Diabetes-Related Lower Extremity Amputations In The United States: A Systematic Review. Health Aff (Millwood). 2022;41(7):985-993.
12. Kim J. The pathophysiology of diabetic foot: a narrative review. J Yeungnam Med Sci. 2023 Oct 31;40(4):328–34.
13. Gallagher KA, Mills JL, Armstrong DG, Conte MS, Kirsner RS, Minc SD, et al. Current Status and Principles for the Treatment and Prevention of Diabetic Foot Ulcers in the Cardiovascular Patient Population: A Scientific Statement From the American Heart Association. Circulation [Internet]. 2024 Jan 23 [cited 2024 Jun 15];149(4). Available from: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001192
14. Tang F, Abdul Razak SNB, Tan JX, Choke ETC, Zainudin SB. Fast-Access Multidisciplinary Approach to Management of Diabetic Foot Ulcers: The Diabetic Rapid Evaluation and Lower Limb Amputation Management (DREAM) Clinic. Clin Med Insights Endocrinol Diabetes. 2023 Jan;16:11795514231196464.
15. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010 Sep;25(9):603–5.
16. Jamovi. The jamovi project [Internet]. Sydney, Australia,: Jamovi; 2023. (jamovi (Version 2.3)). Available from: https://www.jamovi.org
17. JBI Summary. Joanna Bring Institute Summary ( System for the Unified Management of the Assessment and Review of Informatio) [Internet]. North Adelaide, Australia: The University of Adelaide; 2024. Available from: https://sumari.jbi.global/
18. Aalaa M, Vahdani AM, Mohajeri Tehrani M, Mehrdad N, Zohdirad M, Sadati M, et al. Epidemiological Insights into Diabetic Foot Amputation and its Correlates: A Provincial Study. Clin Med Insights Endocrinol Diabetes. 2024 Jan;17:11795514241227618.
19. Bal BS, Khanna G, Bhardwaj A, Singh K. Evaluation of risk factors for lower extremity amputation in diabetic foot ulcer: a hospital based observational study in Northern India. Int J Res Med Sci. 2019 Mar 27;7(4):1190.
20. Cruz V, Pp P, Ljm T, Ah T. Comparison of WIFi, University of Texas and Wagner Classification Systems as Major Amputation Predictors for Admitted Diabetic Foot Patients: A Prospective Cohort Study. Malays Orthop J. 2020 Nov 1;14(3):114–23.
21. Dinata IGS, Udrayana O, Pratama AAGW. High ulcer severity and amputation prevalence of diabetic foot infection patients in Buleleng Regency General Hospital Bali. Multidiscip J Sci Med Res. 2022;13(2):629–31.
22. Guo Z, Yue C, Qian Q, He H, Mo Z. Factors associated with lower-extremity amputation in patients with diabetic foot ulcers in a Chinese tertiary care hospital. Int Wound J. 2019;16(6):1304–13.
23. Ha JH, Jin H, Park JU. Association between socioeconomic position and diabetic foot ulcer outcomes: a population-based cohort study in South Korea. BMC Public Health. 2021 Dec;21(1):1395.
24. Kamitani F, Nishioka Y, Noda T, Myojin T, Kubo S, Higashino T, et al. Incidence of lower limb amputation in people with and without diabetes: a nationwide 5-year cohort study in Japan. BMJ Open. 2021 Aug;11(8):e048436.
25. Li CI, Cheng HM, Liu CS, Lin CH, Lin WY, Wang MC, et al. Association between glucose variation and lower extremity amputation incidence in individuals with type 2 diabetes: a nationwide retrospective cohort study. Diabetologia. 2020 Jan;63(1):194–205.
26. Lo ZJ, Chandrasekar S, Yong E, Hong Q, Zhang L, Chong LRC, et al. Clinical and economic outcomes of a multidisciplinary team approach in a lower extremity amputation prevention programme for diabetic foot ulcer care in an ASIAN population: A case‐control study. Int Wound J. 2022 May;19(4):765–73.
27. Madmoli M, Madmoli Y, Taqvaeinasab H, Khodadadi M, Darabiyan P, Rafi A. Some influential factors on severity of diabetic foot ulcers and Predisposing of limb amputation: A 7-year study on diabetic patients. Int J Ayurvedic Med. 2019 Apr 3;10(1):75–81.
28. Meng L, Graves N, Du RC, Lee JY, Chue KM, Binte Taufiq Chong Ah Hoo NNF, et al. Major limb amputation and mortality in patients with neuro‐ischaemic lower extremity wounds managed in a tertiary hospital: Focus on the differences among patients with diabetes, peripheral arterial disease and both. Int Wound J. 2022 Oct;19(6):1298–308.
29. Rastogi A, Goyal G, Kesavan R, Bal A, Kumar H, Mangalanadanam, et al. Long term outcomes after incident diabetic foot ulcer: Multicenter large cohort prospective study (EDI-FOCUS investigators) epidemiology of diabetic foot complications study. Diabetes Res Clin Pract. 2020 Apr;162:108113.
30. Riaz M, Miyan Z, Waris N, Zaidi SIH, Tahir B, Fawwad A, et al. Impact of multidisciplinary foot care team on outcome of diabetic foot ulcer in term of lower extremity amputation at a tertiary care unit in Karachi, Pakistan. Int Wound J. 2019 Jun;16(3):768–72.
31. Rosedi A, Hairon SM, Abdullah NH, Yaacob NA. Prognostic Factor of Lower Limb Amputation among Diabetic Foot Ulcer Patients in North-East Peninsular Malaysia. Int J Environ Res Public Health. 2022 Oct 31;19(21):14212.
32. Seth A, Attri A, Kataria H, Kochhar S, Seth S, Gautam N. Clinical profile and outcome in patients of diabetic foot infection. Int J Appl Basic Med Res. 2019;9(1):14.
33. Thewjitcharoen Y, Sripatpong J, Krittiyawong S, Porramatikul S, Srikummoon T, Mahaudomporn S, et al. Changing the patterns of hospitalized diabetic foot ulcer (DFU) over a 5-year period in a multi-disciplinary setting in Thailand. BMC Endocr Disord. 2020 Dec;20(1):89.
34. Yunir E, Hidayah CD, Harimurti K, Kshanti IAM. Three Years Survival and Factor Predicting Amputation or Mortality in Patients with High Risk for Diabetic Foot Ulcer in Fatmawati General Hospital, Jakarta. J Prim Care Community Health. 2022 Jan;13:215013192110637.
35. Haddaway NR, Page M, Pritchard CC, McGuinness L A. PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis Campbell Systematic Reviews. 2020;
36. Li CI, Cheng HM, Liu CS, Lin CH, Lin WY, Wang MC, et al. Association between glucose variation and lower extremity amputation incidence in individuals with type 2 diabetes: a nationwide retrospective cohort study. Diabetologia. 2020 Jan;63(1):194–205.
37. Wang X, Yuan CX, Xu B, Yu Z. Diabetic foot ulcers: Classification, risk factors and management. World J Diabetes. 2022 Dec 15;13(12):1049–65.
38. Riandini T, Pang D, Toh MPHS, Tan CS, Liu DYK, Choong AMTL, et al. Diabetes-related lower extremity complications in a multi-ethnic Asian population: a 10 year observational study in Singapore. Diabetologia. 2021 Jul;64(7):1538–49.
39. Negash W, Assefa T, Sahiledengle B, Tahir A, Regassa Z, Feleke Z, et al. Prevalences of diabetic foot ulcer and foot self-care practice, and associated factors in adult patients with diabetes in south-east Ethiopia. J Int Med Res. 2022 Oct;50(10):030006052211290.
40. Bus SA, Sacco ICN, Monteiro‐Soares M, Raspovic A, Paton J, Rasmussen A, et al. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev. 2024 Mar;40(3):e3651.
41. Lazzarini PA, Pacella RE, Armstrong DG, Van Netten JJ. Diabetes‐related lower‐extremity complications are a leading cause of the global burden of disability. Diabet Med. 2018 Sep;35(9):1297–9.
42. Burhan A, Arofiati F, Abreu Da Silva V, Mixrova Sebayang S. Effect of ankle brachial index (abi) and compression therapy on diabetic foot ulcer healing. Curr Diabetes Rev [Internet]. 2023 Mar 31 [cited 2023 Jul 11];19. Available from: https://www.eurekaselect.com/215277/article
43. Burhan A, Arofiati F. Effect of Compression Bandage on the Healing of Diabetic Foot Ulcers: A Scooping Review: In Yogyakarta, Indonesia; 2021 [cited 2024 Jun 19]. Available from: https://www.atlantis-press.com/article/125951201
44. Zhang H, Huang C, Bai J, Wang J. Effect of diabetic foot ulcers and other risk factors on the prevalence of lower extremity amputation: A meta‐analysis. Int Wound J. 2023 Oct;20(8):3035–47.
45. Burhan A, Sebayang SM. The Combination of Polyhexamethylene Biguanide and Cadexomer Iodine in Healing Chronic Venous Leg Ulcers: A Case Report. Viva Med J Kesehat Kebidanan Dan Keperawatan. 2022 Sep 27;16(1):12–21.
46. Burhan A, Ali Khusein N bin, Sebayang SM. Effectiveness of negative pressure wound therapy on chronic wound healing: A systematic review and meta-analysis. Belitung Nurs J. 2022 Dec 27;8(6):470–80.
47. Lavery LA, Ryan EC, Ahn J, Crisologo PA, Oz OK, La Fontaine J, et al. The Infected Diabetic Foot: Re-evaluating the Infectious Diseases Society of America Diabetic Foot Infection Classification. Clin Infect Dis. 2020 Apr 10;70(8):1573–9.
48. Fu X, Ding H, Miao W, Mao C, Zhan M, Chen H. Global recurrence rates in diabetic foot ulcers: A systematic review and meta‐analysis. Diabetes Metab Res Rev. 2019 Sep;35(6):e3160.
49. Bellia A, Meloni M, Andreadi A, Uccioli L, Lauro D. Geographic and Ethnic Inequalities in Diabetes-Related Amputations. Front Clin Diabetes Healthc. 2022 Mar 11;3:855168.
50. Liao X, Li SH, El Akkawi MM, Fu X bing, Liu H wei, Huang Y sheng. Surgical amputation for patients with diabetic foot ulcers: A Chinese expert panel consensus treatment guide. Front Surg. 2022 Nov 8;9:1003339.
51. Boyko EJ, Zelnick LR, Braffet BH, Pop-Busui R, Cowie CC, Lorenzi GM, et al. Risk of Foot Ulcer and Lower- Extremity Amputation Among Participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study. Diabetes Care. 2022;45:357–64.
52. Mansoor Z, Modaweb A. Predicting Amputation in Patients With Diabetic Foot Ulcers: A Systematic Review. Cureus [Internet]. 2022 Jul 25 [cited 2024 Jun 8]; Available from: https://www.cureus.com/articles/82497-predicting-amputation-in-patients-with-diabetic-foot-ulcers-a-systematic-review
53. Boulton AJM. IDF Diabetes Atlas 10th edition scientific committee [Internet]. 10th ed. International Diabetes Federation, Brussels; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK581935/?report=reader
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