Vol. 7, Issue 1, Part A (2025)

Introduction: Diabetes mellitus is a chronic metabolic disorder affecting millions worldwide, with diabetic foot ulcers (DFUs) being a devastating complication occurring in 15-25% of patients during their lifetime. Lower extremity amputation is a life-altering outcome in DFU patients, carrying a five-year mortality rate of up to 70%. This study aimed to comprehensively assess risk factors for amputation in patients with diabetic foot ulcers to develop more effective prevention strategies.
Methods: This ambispective study included 90 patients with diabetic foot ulcers from February 2023 to March 2025. Comprehensive clinical assessments included peripheral neuropathy testing, peripheral arterial disease evaluation through Ankle-Brachial Index (ABI), wound classification, and laboratory investigations including HbA1c. Risk factors assessed included glycemic control, peripheral vascular disease, neuropathy, infection, osteomyelitis, Charcot foot, gangrene, BMI, smoking status, and ulcer characteristics. Statistical analysis was performed using SPSS 20.0, with p<0.05 considered significant.
Results: Of 90 patients, 42% ultimately underwent amputation. Poor glycemic control (HbA1c >6.5%) was present in 95.2% of amputated patients versus 72.4% of non-amputated patients (p=0.07). Peripheral neuropathy was prevalent (66%), with no significant difference between groups. Ulcer healing status showed the strongest association with amputation (p<0.001), with 85.7% of amputated patients having non-healing ulcers compared to 37.9% in the non-amputated group. MRI evidence of osteomyelitis showed a significant association with amputation outcome (p=0.03). Neither smoking status (p=0.74) nor hypertension (p=0.917) showed statistically significant associations with amputation.
Conclusion: This study highlighted the multifactorial nature of amputation risk in DFU patients. Ulcer healing status emerged as the strongest predictor of amputation, while glycemic control showed a trending association. The results emphasize the importance of a comprehensive approach to DFU management, focusing on early detection, aggressive wound care, and tight glycemic control to reduce amputation rates in this vulnerable population.