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Risk Factors for Amputation in Diabetics
- Lisa G. Newman, MD; and
- Alex Stagnaro-Green, MD
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TO THE EDITOR:
We congratulate Drs. Reiber and Koepnell, and the late Dr. Pecoraro on their comprehensive research describing multiple risk factors for foot amputation in diabetics [1]. However, two issues render the data difficult to interpret.
First, the basis for the decision to amputate in both cases and controls with infection is critical. This is especially true for osteomyelitis, which underlies 68% of diabetic foot ulcers and for which clinical judgment is an insensitive diagnostic tool [2]. Early diagnosis and treatment of diabetic foot osteomyelitis in nongangrenous limbs in some cases could have altered group assignments by obviating the need for amputation, as could different preferences for treating osteomyelitis [3].
Second, because ulcers and infections are the major predisposing factors to amputation [4] the relative risks identified for amputation may actually be relative risks for ulceration and infection in the feet of diabetic patients. Data analysis using controls with and without ulcerations or infections would be of interest.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
