Clinical research studyCharcot Arthropathy Risk Elevation in the Obese Diabetic Population
Section snippets
Data and Study Sample
The Institutional Review Board at the Edward Hines Jr VA Hospital approved the study, including a Health Insurance Portability and Accountability Act waiver of authorization.
We used the Department of Veterans Affairs (VA) inpatient and outpatient datasets16 for the fiscal year 2003 (October of 2002 to September of 2003; all years henceforth are fiscal years) to identify patients in the study sample and those with Charcot arthropathy. These datasets contain administrative records of all
Results
The study sample consisted of 561,597 persons who had diabetes and had height and weight measured at least once in 2003. A total of 652 persons in the sample were newly diagnosed with Charcot arthropathy in 2003 with an incidence rate of 1.2 per 1000 persons. Its incidence rates were highest among those aged 55 to 64 years (1.9/1000) and decreased as patients became older, with those 65 years or older having an incidence rate less than 1.0 per 1000 patients (Table 1). Married persons had lower
Discussion
This study shows that obesity is significantly associated with an increased incidence of Charcot arthropathy and that its association is amplified in the presence of peripheral neuropathy. When obesity was present along with neuropathy, the risk of developing Charcot arthropathy increased more than would be expected from the sum of independent effects of these conditions in isolation. For example, obesity alone increased its incidence rates by 59% and neuropathy alone increased its incidence
Limitations
This study has several limitations. First, we did not have access to non-VA data, notably Medicare data for elderly veterans. To evaluate methodological robustness in identifying diabetics among VA users, we compared the VA diabetes prevalence with the estimated prevalence from the 2003 Behavioral Risk Factor Surveillance System, a large survey database on a sample representative of the US population that included questions about VA user status and whether the respondent had diabetes. We found
Conclusions
We have shown that obesity is an independent and significant risk factor for Charcot arthropathy. The obese diabetic patient with coexisting peripheral neuropathy is particularly at high risk for developing Charcot arthropathy. These patients need to be provided with increased vigilance in the assessment of lower-extremity injuries. Annual foot screening, special scrutiny, and education need to be provided to patients with multiple risk factors. Once screening has identified elevated risks,
Acknowledgments
We thank Jack Bates of the VHA Corporate Data Warehouse, for providing height and weight data for the study sample, and Lishan Cao and Huiyuan Zhang, for programming support. The corresponding author had full access to all of the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis.
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Financial support was received from the Center for Management of Complex Chronic Care, Hines VA Hospital, Hines, Illinois (LIP 42-512; Elly Budiman-Mak, MD, Principal Investigator). The article presents the findings and conclusions of the authors; it does not necessarily represent the Department of Veterans Affairs or Health Services Research and Development Service. The authors have no financial or personal conflict of interest to declare.