Endocrine Abstracts

Background

Diabetic nephropathy complicated by albuminuria along with low estimated glomerular filtrate rate (eGFR) are a typical feature of Type 2 Diabetes (T2D) and it’s related to a significant increase in mortality and chronic complications in diabetic patients However, data from the literature are still not conclusive regarding the direct association between albuminuria and risk of amputation for ischemic limb vascular disease, in diabetic patients. Therefore, in the present study we aimed to explore this association in a cohort of elderly diabetic patients treated with surgery for critical ischemic limb vascular disease.

Material and methods

We enrolled hospitalized patients for the management of the diabetic foot with critical ischemia of the lower limbs from February to November 2019 at the Unit of Endocrinology and Diabetology. The study cohort had the following characteristics: 1) 118 patients in total (82 men/35 female); 2) mean age 67.15 years (± 11.49 years S.D.); 3) mean average duration of T2D 19.59 years (± 11.83 years S.D.); 4) mean of body mass index (BMI) 28.64 kg/m² (± 5.55 kg/m² S.D.); 5) mean of HbA_1c: 8.4%–68 mmol/mol (± 1.87%- mmol/mol S.D.); 6) mean eGFR 84.24 ± 42.01 ml/min s.d. Patients were divided in 3 groups considering the surgical approach: 1) 78 patients treated with revascularization of the lower limb; 2) 34 patients treated with conservative medical treatment of the lesson; 3) 16 amputee patients, 10 out of 16 had already performed at least one procedure of revascularization during hospitalization. Linear regression model was used to find association between different groups and investigated outcomes. A P<0.05 was considered statistically significant.

Results

Macroalbuminuria were significanlty increased in patients who had a major amputation limb intervention (distal or proximal), when compared to non-amputated patients. In the same cohort, PCR values increased while eGFR values reduced in the amputee when compared to the non-amputee patients. Conversely, no significant difference was present comparing blood glucose values between the groups. Interesting, a trend for an increase on triglycerides level (P = 0.06) was present in amputee compared to non-amputees patients.

Conclusions

The present study reports as diabetic patients with critical ischemia of the lower limbs, and with chronic kidney disease, specifically with renal failure and increased levels of macroalbuminuria, have a significant increase in the risk of amputation. In addition, there was a specific correlation between major amputation and a high degree of marker of inflammations. Further studies in a larger population are needed to confirm present results.