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Impact of diabetes mellitus on treatment outcomes of tuberculosis patients in tertiary care setup

Sulaiman SAS, Khan AH, Ahmad N, Iqubal MS, Muttalif AR, Hassali MA

Am J Med Sci, 2013 Apr;345(4):321-325.
PMID: 23531965 DOI: 10.1097/MAJ.0b013e318288f8f3

BACKGROUND: Concurrent diabetes mellitus (DM) with tuberculosis (TB) has an increased risk of treatment failure. This study was aimed to evaluate treatment outcomes in patients with TB with and without DM.

METHODS: A retrospective cohort study was conducted at respiratory clinic of Hospital Pulau Pinang, Malaysia. All TB-registered patients from January 2006 to December 2007 were included in the study. A validated data collection form was used for collecting data. World Health Organization's criterion was used for categorizing treatment outcomes. Data were analyzed by using SPSS 16.

RESULTS: Of 1267 patients, 338 patients (26.7%) had concurrent TB-DM. In multivariate analysis, TB-DM was more likely to be present in Chinese (odds ratio [OR] = 1.401, P = 0.011), patients having age of 46 to 60 years (OR = 3.168, P < 0.001) and >60 years (OR = 2.524, P < 0.001) and patients with pulmonary TB (OR = 2.079, P < 0.001). Nine hundred and eighty-five (78.8%) patients were successfully treated. No statistically significant difference was observed between 2 groups: patients with TB-DM and patients with only TB. Successful treatment outcomes were observed in patients having age of 46 to 60 (OR = 1.567, P = 0.001), whereas male gender (OR = 0.721, P = 0.049) and patients with relapse TB (OR = 0.494, P = 0.002) were less likely to have successful treatment outcome.

CONCLUSIONS: High prevalence of TB-DM in the study signifies the fact that patients with DM are at high risk of developing TB. Treatment outcomes in both groups were comparable. The gender-based and age-based disparity in TB treatment outcomes in this study indicates the importance of gender-specific and age-specific strategies of TB management.

Study site: respiratory clinic of Hospital Pulau Pinang

Matched MeSH terms: Diabetes Complications/drug therapy*; Diabetes Complications/epidemiology
Dynamics of Diabetes and Obesity: An Alarming Situation in the Developing Countries in Asia

Chakraborty C, Das S

Mini Rev Med Chem, 2016;16(15):1258-1268.
PMID: 27145852 DOI: 10.2174/1389557516666160505115512

The incidence of diabetes in developing countries in Asia has increased over the last few years. The economic development is radically changing the lifestyle of the younger generation who prefer to embrace the western lifestyle of eating high calorie fast food with minimal physical exercise. Previously, the rate of diabetes was very low but it is increasing at an alarming rate in the developing countries in Asia. Admittedly, there is paucity of literature on the prevalence of patients with type-1 diabetes in Asian developing countries due to lower field surveys and lack of quantitative data. Few contributing factors such as body mass index (BMI) and its relation with obesity and diabetes, energy dense diet, excessive caloric intake, sedentary behaviors, lifestyle and family history, gene and genomewide association of diabetes, genes and gene polymorphisms are being discussed especially with regard to the Asian population. Dynamics of the diabetes and obesity was depicted for the population of Asian developing countries with special emphasis on China and India. Diabetes has become widespread among the low-income communities. Hence, it is necessary to develop appropriate healthcare policies in order to mitigate this rampant epidemic before it is too late.

Matched MeSH terms: Diabetes Complications/epidemiology; Diabetes Complications/prevention & control
Fulltext Psychological aspects of diabetes care: Effecting behavioral change in patients

Chew BH, Shariff-Ghazali S, Fernandez A

World J Diabetes, 2014 Dec 15;5(6):796-808.
PMID: 25512782 DOI: 10.4239/wjd.v5.i6.796

Patients with diabetes mellitus (DM) need psychological support throughout their life span from the time of diagnosis. The psychological make-up of the patients with DM play a central role in self-management behaviors. Without patient's adherence to the effective therapies, there would be persistent sub-optimal control of diseases, increase diabetes-related complications, causing deterioration in quality of life, resulting in increased healthcare utilization and burden on healthcare systems. However, provision of psychosocial support is generally inadequate due to its challenging nature of needs and demands on the healthcare systems. This review article examines patient's psychological aspects in general, elaborates in particular about emotion effects on health, and emotion in relation to other psychological domains such as cognition, self-regulation, self-efficacy and behavior. Some descriptions are also provided on willpower, resilience, illness perception and proactive coping in relating execution of new behaviors, coping with future-oriented thinking and influences of illness perception on health-related behaviors. These psychological aspects are further discussed in relation to DM and interventions for patients with DM. Equipped with the understanding of the pertinent nature of psychology in patients with DM; and knowing the links between the psychological disorders, inflammation and cardiovascular outcomes would hopefully encourages healthcare professionals in giving due attention to the psychological needs of patients with DM.

Matched MeSH terms: Diabetes Complications
Fulltext Comparing the disease profiles of adult patients with type 2 diabetes mellitus attending four public health care facilities in Malaysia

Chew BH, Mastura I, Bujang MA

Malays Fam Physician, 2013;8(3):11-8.
PMID: 25893052 MyJurnal

AIM: We examined disease profiles of patients with type 2 diabetes mellitus (T2D) at four different public health facilities in Malaysia to determine which site would be the most suitable for early and intensive diabetes care against diabetes-related complications.
METHODS: This study analysed 57,780 T2D patients in the Adult Diabetes Control and Management registry database in the year 2009. The four public health facilities were hospital with specialists (HS), hospital without specialists (HNS), health clinics with family medicine specialists (CS) and health clinic without doctors (CND). Descriptive analyses were used to examine age, duration of diseases, intervals from the onset of diabetes to co-morbidities (hypertension and dyslipidaemia) and complication of T2D patients at the four public health facilities.
RESULTS: Patients were significantly older in HS. Patients with T2D at HS had significantly longer duration of diabetes, hypertension and dyslipidaemia. Health clinics, both the CS and the CND, were seeing T2D patients with shorter duration of macrovascular and microvascular complications.
CONCLUSION: Public health clinics in this country managed T2D patients who were younger and at the early stage of diabetes, hypertension, dyslipidaemia and complications. Thus, primary care physicians are best positioned to provide early and intensive diabetes care for this group of T2D patients to prevent the development of diabetes-related complications.
KEYWORDS:
diabetes complications; disease management; health facilities; primary health care; type 2 diabetes mellitus
Study name: Adult Diabetes Control and Management (ADCM) 2009

Matched MeSH terms: Diabetes Complications
Age ≥ 60 years was an independent risk factor for diabetes-related complications despite good control of cardiovascular risk factors in patients with type 2 diabetes mellitus

Chew BH, Ghazali SS, Ismail M, Haniff J, Bujang MA

Exp Gerontol, 2013 May;48(5):485-91.
PMID: 23454736 DOI: 10.1016/j.exger.2013.02.017

Providing effective medical care for older patients with type 2 diabetes mellitus (T2D) that may contribute to their active aging has always been challenging. We examined the independent effect of age ≥ 60 years on disease control and its relationship with diabetes-related complications in patients with T2D in Malaysia. This was a cross-sectional study using secondary data from the electronic diabetes registry database Adult Diabetes Control and Management (ADCM). A total of 303 centers participated and contributed a total of 70,889 patients from May 2008 to the end of 2009. Demographic data, details on diabetes, hypertension, dyslipidemia and their treatment modalities, various risk factors and complications were updated annually. Independent associated risk factors were identified using multivariate regression analyses. Fifty-nine percent were female. Malay comprised 61.9%, Chinese 19% and Indian 18%. There were more Chinese, men, longer duration of diabetes and subjects that were leaner or had lower BMI in the older age group. Patients aged ≥ 60 years achieved glycemic and lipid targets but not the desired blood pressure. After adjusting for duration of diabetes, gender, ethnicity, body mass index, disease control and treatment, a significantly higher proportion of patients ≥ 60 years suffered from reported diabetes-related complications. Age ≥ 60 years was an independent risk factor for diabetes-related complications despite good control of cardiovascular risk factors. Our findings caution against the currently recommended control of targets in older T2D patients with more longstanding diseases and complications.
Study name: Adult Diabetes Control and Management (ADCM) 2009

Matched MeSH terms: Diabetes Complications/blood; Diabetes Complications/etiology*; Diabetes Complications/epidemiology
Fulltext Association of the receptor for advanced glycation end-products (RAGE) gene polymorphisms in Malaysian patients with chronic kidney disease

Wong FN, Chua KH, Kuppusamy UR, Wong CM, Lim SK, Tan JA

PeerJ, 2016;4:e1908.
PMID: 27114872 DOI: 10.7717/peerj.1908

Chronic kidney disease (CKD) is a condition associated with progressive loss of kidney function and kidney damage. The two common causes of CKD are diabetes mellitus and hypertension. Other causes of CKD also include polycystic kidney disease, obstructive uropathy and primary glomerulonephritis. The receptor for advanced glycation end-products (RAGE) is a multi-ligand cell surface receptor of the immunoglobulin superfamily and it has been associated with kidney disease in both non-diabetic and diabetic patients. Presently, data on the association between RAGE polymorphisms and CKD in the Malaysian population is limited, while numerous studies have reported associations of RAGE polymorphisms with diabetic complications in other populations. The present study aims to explore the possibility of using RAGE polymorphisms as candidate markers of CKD in Malaysian population by using association analysis.

Matched MeSH terms: Diabetes Complications
Fulltext Impact assessment of pharmacist-supervised intervention on health-related quality of life of newly diagnosed diabetics: A pre-post design

Upadhyay DK, Mohamed Ibrahim MI, Mishra P, Alurkar VM

J Pharm Bioallied Sci, 2020 07 18;12(3):234-245.
PMID: 33100782 DOI: 10.4103/jpbs.JPBS_6_20

Introduction: Diabetics face a series of challenges that affect all aspects of their daily life. Diabetes related complications adversely affect patient's health-related quality of life (HRQoL). Knowledge and self-care skills of diabetics are corner stones to improve their HRQoL.
Objective: To assess the impact of pharmacist-supervised intervention on HRQoL of newly diagnosed diabetics using an Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire.
Materials and Methods: A pre-post comparison study was conducted among the control group (CG), test 1 group (T1G) and test 2 group (T2G) patients with three treatment arms to explore the impact of pharmacist-supervised intervention on HRQoL of newly diagnosed diabetics for 18 months. Patients' HRQoL scores were determined using ADDQoL questionnaire at baseline, 3, 6, 9 and 12-months. T1G patients received pharmacist's intervention whereas T2G patients received diabetic kit demonstration in addition to pharmacist's intervention. CG patients were deprived of pharmacist intervention and diabetic kit demonstration, and only received care from attending physician/nurses. Non-parametric tests were used to find the differences in an average weighted impact scores (AWIS) among the groups before and after the intervention at P ≤ 0.05.
Results: Friedman test identified significant (P < 0.001) improvement in AWIS among the test groups' patients. Differences in scores were significant between T1G and T2G at 6-months (P = 0.033), 9-months (P < 0.001) and 12-months (P < 0.001); between CG and T1G at 12-months (P < 0.001) and between CG and T2G at 9-months (P < 0.001) and 12-months (P < 0.0010) on Mann.Whitney U test.
Conclusion: Pharmacist's intervention improved AWIS of test groups' diabetics. Diabetic kit demonstration strengthened the disease understanding and selfcare skills of T2G patients. Disease and self-care awareness among diabetics should be increased in Nepali healthcare system by involving pharmacists for better patient's related outcomes.

Matched MeSH terms: Diabetes Complications
Fulltext Performance Analysis of Conventional Machine Learning Algorithms for Diabetic Sensorimotor Polyneuropathy Severity Classification

Haque F, Bin Ibne Reaz M, Chowdhury MEH, Srivastava G, Hamid Md Ali S, Bakar AAA, et al.

Diagnostics (Basel), 2021 Apr 28;11(5).
PMID: 33925190 DOI: 10.3390/diagnostics11050801

BACKGROUND: Diabetic peripheral neuropathy (DSPN), a major form of diabetic neuropathy, is a complication that arises in long-term diabetic patients. Even though the application of machine learning (ML) in disease diagnosis is a very common and well-established field of research, its application in diabetic peripheral neuropathy (DSPN) diagnosis using composite scoring techniques like Michigan Neuropathy Screening Instrumentation (MNSI), is very limited in the existing literature.
METHOD: In this study, the MNSI data were collected from the Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials. Two different datasets with different MNSI variable combinations based on the results from the eXtreme Gradient Boosting feature ranking technique were used to analyze the performance of eight different conventional ML algorithms.
RESULTS: The random forest (RF) classifier outperformed other ML models for both datasets. However, all ML models showed almost perfect reliability based on Kappa statistics and a high correlation between the predicted output and actual class of the EDIC patients when all six MNSI variables were considered as inputs.
CONCLUSIONS: This study suggests that the RF algorithm-based classifier using all MNSI variables can help to predict the DSPN severity which will help to enhance the medical facilities for diabetic patients.

Matched MeSH terms: Diabetes Complications
Fulltext Percentage of haemoglobin variants detected during HbA1c analysis in Hospital Kuala Lumpur

Intan Nureslyna, S., Sabariah, M.N., Lim, C.R., Wan Nor Syafiqah, W.S., Chen, D.R., Choy, S.Y., et al.

Malaysian Journal of Medicine and Health Sciences, 2013;9(2):13-17.
MyJurnal

HbA1c is an established index of glycaemic control and correlates strongly with risk of chronic diabetic complications. However, the accuracy of HbA1c measurement can be affected by many factors, among which is the presence of haemoglobin (Hb) variants. The aim of the study was to determine the percentage of Hb variant detected during HbA1c monitoring in Hospital Kuala Lumpur. The study also analysed non-reportable HbA1c results in the presence of Hb variants. A cross-sectional study using retrospective data of HbA1c results over five months’ period was analysed on Biorad Variant II Turbo, a high performance liquid chromatography (HPLC) assay. The Hb variants were grouped either as HbS, HbC, others (Hb variant apart from HbS or C), and a combination of HbS or C with Others. A total of 11,904 patients were included. Only 2.3% (273) had Hb variants; HbS trait (10.3%), others (89%), and the combination of HbS trait with others (0.7%). No patient with HbC variant or its combination was found. Only 2.2% of those with Hb variant had non-reportable HbA1c. Although the percentage of Hb variants detected during HbA1c analysis and non-reportable HbA1c results were low, their presence should be noted.

Matched MeSH terms: Diabetes Complications
Fulltext Management of T1DM in children and adolescents in primary care

Hong Y, Hassan N, Cheah YK, Jalaludin MY, Kasim ZM

Malays Fam Physician, 2017;12(2):18-22.
PMID: 29423125

The Clinical Practice Guidelines on the Management of Type 1 Diabetes Mellitus in Children & Adolescents was developed by a multidisciplinary development group and approved by the Ministry of Health Malaysia in 2015. A systematic review of 15 clinical questions was conducted using the evidence retrieved mainly from MEDLINE and Cochrane databases. Critical appraisal was done using the Critical Appraisal Skills. Recommendations were formulated on the accepted 136 evidences using the principles of Grading Recommendations, Assessment, Development and Evaluation tailored to the local setting. Type 1 diabetes mellitus is a chronic disease, which usually occurs at an early age, and is associated with various complications including retinopathy, nephropathy, neuropathy and cardiovascular morbidity. Good glycaemic control early in the disease results in lower frequency of chronic diabetes complications, which in turn reduces the healthcare cost. Accurate classification of diabetes and optimum management with the aim to achieve glycaemic targets is of utmost importance.

Matched MeSH terms: Diabetes Complications
Mycobacterium avium subsp. paratuberculosis is not discerned in diabetes mellitus patients in Hyderabad, India

Rani PS, Doddam SN, Agrawal S, Hasnain SE, Sechi LA, Kumar A, et al.

Int J Med Microbiol, 2014 Jul;304(5-6):620-5.
PMID: 24863528 DOI: 10.1016/j.ijmm.2014.04.010

Mycobacterium avium ssp. paratuberculosis (MAP) is an obligate intracellular pathogen. It causes chronic intestinal inflammation in ruminants known as Johne's disease and is associated with human Crohn's disease. Furthermore, association of MAP with other autoimmune diseases, such as type-1 diabetes, has been established in patients from Sardinia (Italy) which is a MAP endemic and genetically isolated region. Due to largest livestock population and consequently high MAP prevalence amidst a very high diabetes incidence in India, we sought to test this association on a limited number of patient samples from Hyderabad. Our results of ELISA with MAP lysate and MAP-specific protein MAP3738c as well as PCR/real-time PCR of MAP-specific sequences IS900 and/or f57 indicated that, in contrast to Sardinian diabetic patients, MAP infection in blood is not discerned in diabetic patients in Hyderabad. The association of a mycobacterial trigger with diabetes therefore could well be a population-specific phenomenon, highly dependent on genetic repertoire and the environment of susceptible populations. However, a larger study is needed in order to confirm this.

Matched MeSH terms: Diabetes Complications*
Fulltext Emphysematous pyelonephritis in a diabetic patient with pelvic-ureteric stone

Chan AC, Rohan MJ, Hamid A, Azam A

Med J Malaysia, 2007 Jun;62(2):166-7.
PMID: 18705456 MyJurnal

Emphysematous pyelonephritis is a rare but life threatening infection of kidney that is characterized by gas formation within or around the kidney. We describe a case of emphysematous pyelonephritis as a consequence of inadequately treated pelvic-ureteric stone in a diabetic man and complement this with a brief review of the literature pertaining in particular to the management of this condition.

Matched MeSH terms: Diabetes Complications/etiology*
Fulltext New coronary risk factors: is there a difference between diabetic patients with microalbuminuria compared to those without microalbuminuria?

Yeo CK, Hapizah MN, Khalid BAK, Nazaimoon WMW, Khalid Y

Med J Malaysia, 2002 Sep;57(3):298-303.
PMID: 12440269

Diabetes mellitus is an important risk factor for the development of coronary artery disease. The presence of microalbuminuria, which indicates renal involvement in diabetic patients, influences the progression of coronary artery disease. New coronary risk factors such as C-reactive protein (CRP), Lipoprotein a [Lp (a)] and fibrinogen are increasingly being recognized as important cardiovascular prognostic factors. These new coronary risk factors could account for the worse cardiovascular prognosis in diabetic patients with microalbuminuria. Our cross sectional study was to compare the prevalence of elevated CRP and the levels of Lp (a) and fibrinogen between diabetic patients with microalbuminuria and those without microalbuminuria. Diabetic patients with overt coronary artery disease were excluded from the study. A total of 108 patients were recruited of which 57 patients had microalbuminuria and 51 were without microalbuminuria. There was no difference in the number of patients with elevated CRP between these two groups. There were also no significant differences in the mean values of Lp (a) and fibrinogen between diabetic patients with and without microalbuminuria. The inflammatory marker CRP and coagulopathy markers i.e. Lp (a) and fibrinogen seem not to be perturbed in diabetic patients with microalbuminuria.

Matched MeSH terms: Diabetes Complications*
Implantation and diabetes: analysis of 525 cases

Lim AS, Ang BC, Heng LK, Hart PM, Ngui MS, Chew P, et al.

Ann Acad Med Singap, 1989 Mar;18(2):174-7.
PMID: 2751233

This is a retrospective study of 525 posterior chamber implants in diabetics performed by A S M Lim and B C Ang of Singapore. The patients were reviewed by visiting ophthalmologists--J E Kennedy (Sydney), M Ngui (East Malaysia) and P M Hart (Belfast). This study did not show any significant difference in the complication of post-operative visual acuity between diabetics and non-diabetics. 95% obtained 6/12 vision or better when pre-existing disease was excluded. It also showed that posterior chamber implants can be inserted in eyes with maculopathy or proliferative retinopathy if laser treatment was effectively done before or after surgery.

Matched MeSH terms: Diabetes Complications*
Off-pump coronary artery bypass grafting in a high-risk dextrocardia patient: a case report

Abdullah F, Mazalan SL

Heart Surg Forum, 2004;7(3):E186-8.
PMID: 15262598

We present an interesting but high-risk case of an obese male patient aged 56 years with dextrocardia and a left diaphragmatic hernia. Anterior myocardial infarction was diagnosed in 1994, and the patient later presented with a history of unstable angina. The diagnosis for this chronic smoker was triple-vessel disease, impaired left ventricular function, chronic renal failure, chronic bronchitis, impaired lung function, pulmonary hypertension, hypertension, diabetes, and chronic active gastritis (EuroSCORE of 10). The patient underwent successful off-pump coronary artery bypass grafting with 3 saphenous vein grafts to the left anterior descending, obtuse marginal, and right posterior descending arteries. He was discharged home 8 days later.

Matched MeSH terms: Diabetes Complications/complications*
A contemporary biological pathway of islet amyloid polypeptide for the management of diabetic dementia

Sah SK, Samuel VP, Dahiya S, Singh Y, Gilhotra RM, Gupta G, et al.

Chem Biol Interact, 2019 Jun 01;306:117-122.
PMID: 31004596 DOI: 10.1016/j.cbi.2019.04.022

Major challenges of dealing elder patients with diabetes mellitus (DM) are the individualization of consideration in persons with various comorbid types of conditions. In spite of the fact that microvascular and macrovascular problems associated with DM are well documented, there is only a few numbers of reports viewing different conditions, for example, cognitive dysfunction. Cognitive dysfunction is of specific significance due to its effect on self-care and quality of life. All in all, the etiology of cognitive dysfunction in the maturing populace is probably going to be the grouping of ischemic and degenerative pathology. It is likewise trusted that Hyperglycemia is engaged with the system of DM-related cognitive dysfunction. At present, it isn't certain in the case of enhancing glycemic control or utilizing therapeutic agents can enhance the risk of cognitive decay. Amylin was later characterized as an amyloidogenic peptide, confined from a beta cell tumor and called islet amyloid polypeptide (IAPP), and after that, amylin. Conversely, we investigate the beneficial role and hypothesizing the mechanism of amylin related expanding the level and activation of CGRP receptor to enhance the cognition declination amid diabetic dementia.

Matched MeSH terms: Diabetes Complications/drug therapy*
Subcutaneous gas in diabetes mellitus due to Aerobacter aerogenes infection

Da Costa JL

Med J Malaya, 1969 Mar;23(3):199-202.
PMID: 4240074
Matched MeSH terms: Diabetes Complications*
Oral Thrush

Chaubal T, Bapat R

Am J Med, 2018 09;131(9):e371-e372.
PMID: 29730363 DOI: 10.1016/j.amjmed.2018.04.020
Matched MeSH terms: Diabetes Complications*
The current and future perspectives of zinc oxide nanoparticles in the treatment of diabetes mellitus

Tang KS

Life Sci, 2019 Dec 15;239:117011.
PMID: 31669241 DOI: 10.1016/j.lfs.2019.117011

Diabetes mellitus (DM) is a multifaceted and costly disease, which requires serious attention. Finding a cheaper anti-diabetic alternative that can act on multiple disease-related targets and pathways is the ultimate treatment goal for DM. Nanotechnology has offered some exciting possibilities in biomedical and drug delivery applications. Zinc oxide nanoparticles (ZnO-NPs), a novel agent to deliver zinc, have great implications in many disease therapies including DM. This review summarizes the pharmacological mechanisms by which ZnO-NPs alleviate DM and diabetic complications. Research implications and future perspectives were also discussed.

Matched MeSH terms: Diabetes Complications/drug therapy
Fulltext Quality of life of diabetes amputees following major and minor lower limb amputations

Nazri MY, Aminudin CA, Ahmad FS, Mohd Jazlan MA, Jamalludin Ab R, Ramli M

Med J Malaysia, 2019 02;74(1):25-29.
PMID: 30846658

INTRODUCTION: Minor amputation was performed as a salvage procedure because most of the patients were not able to ambulate and become dependent following major amputation. Minor amputation is defined as amputation at the level of ankle joint and below while major amputation is defines by amputation above the ankle joint. The aim of this study was to compare the quality of life among diabetes patients following major and minor amputations.

METHODS: A total of 94 diabetes patients were reviewed six months following amputation. Their walking ability, dependency status and quality of life were evaluated, using the Malay translated version of the Short Form Health Survey 36 (SF-36) questionnaire.

RESULTS: During the follow up only three patients (8.3%) following major amputation were dependant compared to 30 patients (51.7%) following minor amputation. Forty-nine (84.5%) of minor amputation and only 15 (41.7%) of major amputation patients were ambulating independently. Patients with minor amputation have significantly better Physical functioning, Role - physical, General health, Role - emotional, and Mental health score (p<0.001). However, they have worse BP and SF score than those following major amputation (p<0.001). The VT score of both groups were not significantly different.

CONCLUSION: Patients with minor amputation are more independent, ambulatory and had better quality of life than those with major amputation. Despite the risk of persistent infection and amputation stump complication, minor amputation should be attempted in diabetes patients.

Matched MeSH terms: Diabetes Complications/surgery*

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