Impact of Diabetes on Outcomes after Lower Limb Revascularization in Patients with Chronic Limb-Threatening Ischemia: A Systematic Review and Meta-Analysis.
Raíssa Estevam, Gabriela Rocha, Lívia Morais et al.
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In 30 seconds
This systematic review and meta-analysis examined whether diabetes was associated with mortality or major amputation after lower-extremity revascularization for chronic limb-threatening ischemia (CLTI). It pooled 10 observational studies involving 50,242 patients, each with at least one year of follow-up. Overall, diabetes was associated with higher all-cause mortality (HR 1.23; 95% CI 1.04-1.46) and major amputation (HR 1.43; 95% CI 1.23-1.66). In duration-based analyses, the amputation association was significant at ≥3 years, while mortality differences were not significant at either follow-up interval.
Key findings
- Across pooled studies, diabetes was associated with higher all-cause mortality (HR 1.23; 95% CI 1.04-1.46; I 2 = 87.6%).
- Diabetes was associated with higher major amputation risk overall (HR 1.43; 95% CI 1.23-1.66; I 2 = 62.3%).
- At ≥3 years, major amputation risk was significantly higher with diabetes (HR 1.56; 95% CI 1.32-1.85; P < 0.001); the mid-term difference was nonsignificant.
- Mortality differences were nonsignificant at mid-term (HR 1.36; 95% CI 0.97-1.90; P = 0.075) and long-term follow-up (HR 1.18; 95% CI 0.95-1.46; P = 0.10).
Why it matters
The findings suggest that diabetes may mark greater long-term limb risk after revascularization for CLTI, even though mortality differences were not significant in the follow-up subgroups. This distinction can inform how clinicians interpret risk over time and supports attention to ongoing limb outcomes, while the observational evidence does not establish that diabetes itself causes these outcomes.
What to keep in mind
The evidence comes from observational studies, and substantial heterogeneity persisted across analyses, limiting certainty about the pooled associations.