Lower Extremity Amputations (LEA) and Diabetic Retinopathy (DR) are debilitating complications in patients with T2DM. We prospectively explored the association of grades of DR with the outcomes and the risk factors in patients (n=2500) with LEA (January 2011 to December 2017) Goodness of fit was examined using Pearson Chi Square test. Severe neuropathy (n=1341, 53.6%), osteomyelitis (n=1274, 50.9%), and gangrene (n=1242, 49.6%), were the predominant comorbidities. DR was observed in 56% (n=1400) of patients (NPDR n=962, 38%; PDR n=438, 16%). DR and LEA were strongly related with the highest association observed for amputations of both lower limbs (n=640), followed by above knee (n=365), below knee (n=249) and toes (n=146) (p<0.00001). 73.8% of patients with DR (n=1034) had HbA1c >11%. The seven year follow-up was characterized by a high incidence of new diabetic ulcers and amputations (62.8% n=1571, p<0.00001). The incidence of new ulcers was highest in the NPDR group (n=483, 50.2%) whereas the incidence of new amputations was highest in the PDR group (n=238, 54.3%). The all-cause mortality was 41.9% (n=1048, p<0.00001). Patients with NPDR reported highest mortality (n=508, 48.4%). Myocardial Infarction (n=316, 30.01%) was leading cause of mortality in patients with NPDR (n=237, 42.3%) whereas Congestive Heart Failure (n=604, 57.6%), was predominant cause of mortality in patients with PDR (n=350, 70.5%) (p<0.00001). The incidence of mortality 29.4% (n=308) was highest in the 7th year of follow-up. We observed that grades of DR had independent higher predictive values for new ulcers, new amputations and all-cause mortality. Patients with NPDR had worst outcomes. This long-term prospective study highlights the importance of grades of DR to predict outcomes beyond ocular morbidity and implement an integrated multidisciplinary approach for this composite complication, as a consequence of diabetes.

Disclosure

K. Shah: None. S. Natarajan: None. V. Parsewar: None. V.K. Shivane: None.

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