| Summary: | 碩士 === 中臺科技大學 === 醫療暨健康產業管理系碩士班 === 104 === Diabetes is a very popular chronic disease, typically Type 2 diabetes. A large number of complications may happen to a patient, of which foot diseases are a common problem. Diabetic foot infection is not only a major reason of hospitalization of diabetes patients but also a key cause of amputation. The objectives of this study were to survey the amputation rates in hospitalized Type 2 diabetes patients over years and to analyze the affecting factors of amputations.
By longitudinal survey, we gathered data on the subjects in the database for national health insurance research. We were able to obtain a total of 243,514 inpatients of Type 2 diabetes as the subjects of study from the data spanned over 2000 - 2010. We analyzed by descriptive statistics the rates of lower extremity amputations in these patients and, by logistic regression analysis, the factors that affected the amputations.
The survey results indicated that in all 426,054 hospitalizations for Type 2 diabetes patients over an 11-year period under study, the rates of major amputation were 2.50 - 3.55% and those of minor amputation were 3.63 - 4.46%. Males than females, the age groups of 80-99, 60-79 and 40-59 than that of 20-39, lower limbs with ulcer than those without, those with peripheral vascular diseases than without, those with cardiovascular diseases than without, those treated in the regions of Kaohsiung and Pingtung, the South and the North than the region of Taipei, and hospitalizations in spring than in winter had higher odds ratios in respect of major amputations. Patients with hypertension than without, those with hyperlipidemia than without, those treated at district and regional hospitals than medical centers, those treated at private hospitals than public ones, hospitalizations in fall than in winter, and those treated during 2004-2010 than in 2000 had lower odds ratios in respect of major amputations. Males than females, the age groups of 80-99, 60-79 and 40-59 than 20-39, lower limbs with ulcer than those without, those with peripheral vascular diseases than without, those treated at private hospitals and non-profit-seeking ones than public ones, and those treated in the regions of Kaohsiung and Pingtung, the South and the Central Taiwan than the region of Taipei had higher odds ratios in respect of minor amputations. Those with cardiovascular diseases than without, those with cerebrovascular diseases than without, those with hypertension than without, those with hyperlipidemia than without, those treated at district and regional hospitals than medical centers, hospitalizations in summer and fall than in winter, and those treated in 2006 and 2004 than in 2000 had lower odds ratios in respect of minor amputations.
The rate of lower extremity amputation in Type 2 diabetes inpatients was found to decrease. Important factors affecting major or minor amputations in Type 2 diabetes inpatients were male, increase of age, lower limbs with ulcers or peripheral vascular diseases, and seasons of hospitalization. In administering health education to diabetes patients, the medical institutions can strengthen the males and the elderly’s knowledge of and information on the influences of common complications to diabetes and seasonal changes on amputations, and preventions, to let them form due behavioral patterns and lead healthy lifestyle, so as to reduce the occurrences of amputation.
Keywords: diabetes, amputation, complication, risk factors
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