Prevalence of lower-extremity amputation among patients with diabetes mellitus: is height a factor?

BACKGROUND Taller diabetic patients are at higher risk of peripheral sensory loss than shorter diabetic patients and thus may be at increased risk of lower-extremity ulcers and amputation. In a large telephone survey, the prevalence of lower-extremity amputation among patients with diabetes mellitus was determined and the association between height and lower-extremity amputation evaluated. METHODS Of 256,036 patients identified from hospital and clinic databases who had a diagnosis of diabetes and were seen at those institutions between 1995 and 1998, 128,572 were randomly selected to be interviewed by telephone between 1995 and 2002. Of the 93,484 patients who agreed to be interviewed, 386 were excluded (age < 18 years); this left 93,116 diabetec patients (42,970 men and 50,146 women) for inclusion in the study. RESULTS Of the 93,116 patients interviewed, 3259 (3.5%) had type 1 diabetes. Lower-extremity amputation was performed in 1.7% and 0.8% of the patients with type 1 and type 2 diabetes, respectively. The prevalence of amputation did not differ significantly between men and women with type 1 diabetes but was significantly higher among men than among women with type 2 diabetes (0.9% v. 0.7%). Height (every 10-cm increment) was significantly associated with lower-extremity amputation (adjusted odds ratio [OR] 1.16, 95% confidence interval [CI] 1.03-1.32). In a subgroup of 9295 patients for whom data on fasting plasma glucose levels and dyslipidemia were available, and after additional adjustment for these 2 variables, body height remained an independent predictor of lower-extremity amputation (adjusted OR for every 10 cm of height 1.79, 95% CI 1.14-2.82). INTERPRETATION Height is an independent predictor of lower-extremity amputation among patients with type 1 and type 2 diabetes mellitus.