• Distance as a risk factor for amputation in patients with diabetes: A case-control study

      Gallagher, D; Jordan, V; Gillespie, P; Cullinan, J; Dinneen, S (Irish Medical Journal, 2014)
      We studied the association between amputation and distance of patientsâ residences to a diabetes care centre. We performed a case-control study matching each case (amputation) with 5 controls (no amputation) by age and sex. We compared the distance of residence to the diabetes centre, duration and type of diabetes, haemoglobin-A1c levels and foot examination findings for cases and controls. We analysed the association between distance and the strongest predictors of amputation. Sixty-six cases of amputation and 313 controls were identified. Distance of residence was 12.1km greater for cases (p=0.028). In multivariate analysis, only diabetes duration (OR/year 1.07, 1.03 to 1.11) and neuropathy (OR 10.73, 4.55 to 25.74) were significantly associated with amputation. Patients with neuropathy resided 9.7km further than those without neuropathy (p=0.01). Patients requiring amputation reside at greater distances from the diabetes centre, possibly due to higher rates of neuropathy