Khalid Usman, Salman Khan Kundi, Mohammad Iftakhar, Tahir Ghaffar Khattak


Background: About 10% of patients with diabetes mellitus present with diabetic foot ulcers. The objective of the study was to determine the predictive role of HbA1c level on progression to lower limb amputation in diabetic patients.
Material & Methods: This was a case-control study conducted between January, 2014 and December, 2015. We collected a matched-pair data for patients with diabetic foot ulcers with or without amputation. Thirty-five patients from each group were statistically analyzed to see the predictive role of HbA1c for amputation.
Results: The mean age of all patients included was 56.06 ±4.6 years with 30(42.9%) males and 40(57.1%) females with a ratio of 1:1.3. Mean HbA1c was found to be 8.85 ±1.4%. A univariate logistic regression showed HbA1c as a predictor of amputation, sensitivity was 60%, specificity was 71.4%, positive predictive value 64.3% and negative predictive value 67.6%. For each unit decrease in HbA1c, the odds of reduction of amputation, reduced by 2.5 times (OR 0.40, 95% CI 0.24 to 0.66, p<0.001). The area under the curve was estimated at 77.9% (95% CI 66.9 to 88.9). The cut-off value of HbA1c for the above stated sensitivity and specificity was at 9.15%.
Conclusion: HbA1c can be effectively used as a laboratory parameter in evaluating diabetic foot ulcer patients and it can be employed as a target to reduce the amputation risk.


Diabetic foot; Amputation; Glycosylated hemoglobin.

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