The Correlation Between Duration of Diabetes Mellitus, Ulcer Grading, HbA1C Levels, and Peripheral Arterial Occlusion to Amputation in Patients with Diabetic Foot Ulcers at Prof. Dr. I.G.N.G Ngoerah Hospital

Background: Diabetic foot ulcers (DFU) are a lower extremity manifestation often associated with morbidity and mortality due to diabetes mellitus. Diabetic foot ulcers arise from chronic pathological processes such as neuropathy, peripheral arterial disease (PAD), biomechanical issues, and impaired wound healing. Even with proper treatment, DFUs can eventually lead to serious complications such as infection, amputation, and even death. The risk factors that contribute to the determination of amputation in patients with diabetic foot ulcers are still debated. Objective: This study aims to determine which factors (duration of DM, ulcer grading, HbA1C level, and peripheral artery occlusion) have the most influence on amputation in DFU patients at Prof. Dr. I.G.N.G Ngoerah Hospital Denpasar. Methods: This study is an analytic observational study, with the design used being a retrospective cohort. The sample was 90 patients with diabetic foot ulcers diagnosed at Prof. Dr. I.G.N.G Ngoerah Hospital from January 2022 to December 2023. Statistical analysis was performed with SPSS ver 20.0 for univariate, bivariate, and multivariate tests. Results: Patient amputation in diabetic foot ulcer patients was associated with HbA1c levels, ulcer grading, and occlusion by 81.44% (p value: 0.046; OR 2.9; IK 0.99-8.59) for HbA1c >6.5, 98.6% (p value 0.001; OR 17.2; IK: 1.80-164.94) for Wagner ulcer grading 3-5, and 95.7% (p value 0.000; OR 22.3; IK: 0.56-4.17) for occlusion. Meanwhile, DM duration <10 years performed amputation for 61.4% (p value 0.088; OR 0.4; IK: 0.15-1.15). Conclusion: HbA1c level, ulcer grading, and occlusion were associated with amputation in diabetic foot ulcer patients, while DM duration was not associated with amputation. The adj value (OR) found that Wagner 3-5 ulcer grading had the most dominant influence compared to other variables, with an OR value of 34.4. This indicates that ulcer grading can predict amputation as much as 34.4 times.