Wukich Dane K, Raspovic Katherine M, Suder Natalie C
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (DKW).
Department of Plastic Surgery, Georgetown University School of Medicine, Washington, DC (KMR).
Foot Ankle Spec. 2018 Feb;11(1):17-21. doi: 10.1177/1938640017694722. Epub 2017 Feb 1.
The aim of this study was to identify the most-feared complications of diabetes mellitus (DM), comparing those with diabetic foot pathology with those without diabetic foot pathology.
We determined the frequency of patients ranking major lower-extremity amputation (LEA) as their greatest fear in comparison to blindness, death, diabetic foot infection (DFI), or end-stage renal disease (ESRD) requiring dialysis. We further categorized the study group patients (N = 207) by their pathology such as diabetic foot ulcer (DFU), Charcot neuroarthropathy, foot infection, or acute neuropathic fractures and dislocations. The control group (N = 254) was comprised of patients with diabetes who presented with common non-diabetes-related foot pathology.
A total of 461 patients were enrolled in this study and included 254 patients without diabetic foot complications and 207 patients with diabetic foot problems. When comparing patients with and without diabetic disease, no significant differences were observed with regard to their fear of blindness, DFI, or ESRD requiring dialysis. Patients with diabetic foot disease (61 of 207, 31.9%) were 136% more likely (odds ratio [OR] = 2.36; 95% CI = 1.51-3.70; P = .002] to rank major LEA as their greatest fear when compared with diabetic patients without foot disease (42 of 254, 16.5%) and were 49% less likely (OR = 0.51; 95% CI = 0.34-0.79; P = .002) to rank death as their greatest fear compared with patients without diabetic foot disease.
Patients with diabetic foot pathology fear major LEA more than death, foot infection, or ESRD. Variables that were associated with ranking LEA as the greatest fear were the presence of a diabetic-related foot complication, duration of DM ≥10 years, insulin use, and the presence of peripheral neuropathy.
Level II: Prospective, Case controlled study.
本研究旨在确定糖尿病（DM）最令人恐惧的并发症，比较有糖尿病足病变的患者与无糖尿病足病变的患者。
我们确定了将大截肢术（LEA）列为最大恐惧的患者频率，并与失明、死亡、糖尿病足感染（DFI）或需要透析的终末期肾病（ESRD）进行比较。我们根据患者的病变情况，如糖尿病足溃疡（DFU）、夏科氏神经关节病、足部感染或急性神经性骨折和脱位，对研究组患者（N = 207）进行了进一步分类。对照组（N = 254）由患有常见非糖尿病相关足部病变的糖尿病患者组成。
本研究共纳入461例患者，其中254例无糖尿病足并发症，207例有糖尿病足问题。在比较有糖尿病和无糖尿病的患者时，他们对失明、DFI或需要透析的ESRD的恐惧没有显著差异。与无足部疾病的糖尿病患者（254例中的42例，16.5%）相比，患有糖尿病足疾病的患者（207例中的61例，31.9%）将大截肢术列为最大恐惧的可能性高136%（优势比[OR]=2.36；95%可信区间[CI]=1.51 - 3.70；P = 0.002），与无糖尿病足疾病的患者相比，将死亡列为最大恐惧的可能性低49%（OR = 0.51；95%CI = 0.34 - 0.79；P = 0.002）。
有糖尿病足病变的患者对大截肢术的恐惧超过对死亡、足部感染或ESRD的恐惧。与将截肢术列为最大恐惧相关的变量包括存在糖尿病相关足部并发症、糖尿病病程≥10年、使用胰岛素以及存在周围神经病变。
二级：前瞻性病例对照研究。
