Circulatory Problems Still Distress Diabetics

For people with diabetes who develop poor circulation in their lower limbs because of the disease, the risk of major amputation and even death is "considerable," Italian researchers report.

However, reducing the amputation rate among people with so-called diabetic foot "is possible," Dr. Giacomo Clerici told Reuters Health, if circulation can be restored using bypass grafts or angioplasty in limbs affected by poor blood flow or "ischemia."

Nowadays, limbs can be "revascularized" in about 95 percent of cases, Clerici said. "At the beginning of the '90s we were only able to revascularize about 25 percent of diabetic patients with critical limb ischemia."

As described in the medical journal Diabetes Care, Clerici, of the Diabetic Foot Center, IRCCS Multimedica, Milan and his colleagues examined data on 564 patients who had been hospitalized at the center between 1999 and 2003. They were followed for an average of almost 6 years.

Angioplasty — opening blocked arteries using a catheter and inflatable balloon — was performed in 420 patients and bypass grafting in 117. Revascularization was not possible for 27 patients.

According to the investigators, major amputations had to be performed in a total of 74 patients — 8 percent of peripheral angioplasty patients, 21 percent of bypass patients, and 59 percent of patients who did not undergo revascularization.

"The rate of amputation was consistently lower in patients that received revascularization compared with patients that could not undergo revascularization," the investigators point out.

During follow-up, 276 patients died. The odds of dying were three times higher among patients with no possibility of revascularization.

"Overall, a multidisciplinary approach is the key to success," Clerici said. "Revascularization and correct foot care improve the prognosis of these patients and reduce the need of other interventions."