Comparação dos fatores de risco para amputações maiores e menores em pacientes diabéticos de um Programa de Saúde da Família

Abstract

Background: The main causes of hospital admission in patients with type 1 and 2 diabetes mellitus include diabetic foot complications, which may result in particularly disabling sequelae, such as lower limb amputation. Peripheral vascular insufficiency is a common early occurrence in these patients. The coexistence of neuropathy, ischemia, and immunodeficiency favors the development of infections in the lower limbs, which if not treated properly can lead to amputation and even death. Objective: Compare risk factors for major and minor amputations in diabetic patients in the Family Health Program of the health care facility CAIC Virgem dos Pobres III, in Maceió, state of Alagoas, Brazil. Methods: We examined 93 patients diagnosed with diabetes, assessing whether or not lower limb amputation was performed. The variables analyzed were: sex, age, type of diabetes, blood pressure, previous amputation (whether major or minor), skin changes, changes in arterial pedal and posterior tibial pulses, deformities, and neuropathy. Variables were classified according to the Wagner and Texas wound classification. Results: All patients were diagnosed with type 2 diabetes. We found that 4.30% of the patients progressed to lower limb amputation. There was no significant variation in hypertension, deformities and neuropathy in relation to the amputee group. However, absence of distal pulses in the lower limb proved to be quite significant in relation to amputation outcome. Conclusion: Diabetic patients should receive appropriate outpatient medical care in order to prevent or minimize diabetes-related complications. Copyright © 2009 by Sociedade Brasileira de Angiologia e de Cirurgia Vascular.