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Abstract
Objective To compare the risk of lower extremity amputation (LEA) in people with diabetes with and without comorbid depression.
Research design and methods A systematic review of the published literature was conducted. Six databases were searched including PubMed, CINAHL, EMBASE, Medline, the Cochrane Library and PsycARTICLES from inception to 22 June 2016, using a detailed search strategy and cross-checking of reference lists for potentially eligible studies published in English. No date restrictions were employed. All studies were reviewed independently for inclusion by two review authors. Data extraction was performed using a standardized data abstraction form, and study quality was assessed independently by two reviewers. A meta-analysis was performed reporting pooled hazard ratios (HRs) and 95% CIs in Review Manager software.
Results In total, seven studies were eligible for inclusion in the systematic review. Data on 767 997 patients from five studies were included in the meta-analysis. Pooled estimates across the studies were obtained using a random-effects model due to significant heterogeneity (I2=87%). People with diabetes and depression had an increased hazard of LEA (HR 1.76, 95% CI 1.19 to 2.60) compared to people with diabetes and no depression.
Conclusions Based on the available evidence, comorbid depression appears to increase the risk of LEA in people with diabetes. Limited data were available, however, with significant heterogeneity between studies. Further research is needed to inform intervention and clinical practice development in the management of diabetes.
- diabetes
- amputation
- depression
- systematic review
- meta-analysis
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Footnotes
Contributors This work was conducted as part of a Masters in Public Health qualification obtained by GM in 2014 from University College Cork, Ireland. GM, CMB and ZK conceived and designed the study. SON and GM performed the systematic searches. SON and CMB screened the titles for inclusion or exclusion, and performed the data extraction and quality appraisal of the studies. SON performed the meta-analysis and drafted the manuscript. All authors critically revised the manuscript for important intellectual content. CMB will act as guarantor for the paper.
Funding Health Research Board Interdisciplinary Capacity Enhancement Award ICE/2012/12 ‘ Lifestyle Transitions and Trajectories through the Lifecourse: Enhancing capacity in Irish cohort and cross-sectional studies’.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
Data sharing statement Data from the meta-analysis are available from the corresponding author on request.