Tobacco and alcohol use as risk factors for major lower extremity amputation in diabetics

Main Article Content

Mohamed E Ahmed
Elsadig S Adam
Shadad M Mahmoud


AbstractAbstractObjectives: This study was designed to asses the prevalence and characteristics of smoking and alcohol drinking among diabetics and non diabetics in Sudan, in addition to evaluation of the relation between thesefactors and major lower extremity amputation (LEA) in diabetics and the role of smoking cessation on the risk of major LEA. Methods: This is a case control study which included 65 male diabetics who had major LEA as cases, 110 diabetics and 110 non diabetics as control groups. A major LEA was defined as any Below Knee Amputation (BKA) or proximal. Results: There was a strongly significant association between smoking >10 cig/d and amputation compared with those who smoked < 10 cig/d. The same significant association was noticed between cumulative smokers of > 20 pack-years versus < 20 pack-years and never smokers. 66.7% of the amputees were heavy alcohol drinkers (200g/week) versus 55.8% of the diabetic controls, O.R 1.59, 95% CI 0.49-5.24, (P=0.55).Conclusion: Cigarette smoking is associated, in a dose response manner, with the rate of amputation. Alcoholdrinking did not show a statistically significant relation to amputation in diabetics.

Article Details

Original Articles


1- Carrington AI, Abbot CA, Griffiths J, et al. A foot
care program for diabetic unilateral lower limb
amputees. Diabetes Care 2001; 24: 216-21.
2- Most RS, Sinnock P. The epidemiology of lower
extremity amputations in diabetic individuals.
Diabetes Care 1983; 6(1): 87-91.
3- Ahmed ME. Diabetic septic foot lesions in
Khartoum. East Afr Med J 1986; 63: 187-190.
4- Laing P. The development and complications of
diabetic foot ulcers. Am J Surg 1998; 176: 1119.
5- Chaturvedi N, Abbott CA, Whalley A, et al. Risk
of diabetes related amputation in South Asians
vs. Europeans in the UK. Diabet Med 2002; 19:
6- The International Working Group on the Diabetic
Foot. International consensus on the diabetic
foot. Practical guidelines. Consensus meeting
May 2007. Available at
7- Burns DM. Nicotine addiction. In: Braunwald E,
Fause AS, Kasper DL et al, editors. Harrison’s
principles of internal medicine. 15th ed, vol 2.
New York: McGraw-Hill Companies; 2001. P.
8- DePalma RG. Atherosclerosis prevention and
risk factor modification. In: White RA, Hollier
LH, editors. Vascular Surgery: basic science and
clinical correlations. 1st ed. Philadelphia: J.B.
Lippincott Company; 1994. P. 533-37.
9- American Diabetes Association. Smoking and
Elsadig S Adam, Shadad M Mahmoud, Mohamed E Ahmed
Diabetes. Diabetes Care 2003; 26: 89-91.
10- Idris AM, Ibrahim YM, Warnakulasurya KA et
al. Toombak use and cigarette smoking in the
Sudan: Estimates of prevalence in the Nile State.
Prev Med 1998; 27: 597-603.
11- Boyko EJ, Oyibo SO, Chalmers N et al.
Peripheral arterial disease in diabetic and non
diabetic patients. Diabetes Care 2001; 24: 143337.
12- Al-Delaimi WK, Willet WC, Manson SE et al.
Smoking and mortality among women with type
2 diabetes. Diabetes Care 2001; 24: 2043-48.
13- Caroline E. Fife, Cem Buyukcakir, Gordon Otto
et al. Factors influencing the outcome of lowerextremity diabetic ulcers treated with hyperbaric
oxygen therapy. Wound Repair and Regeneration
2007; 15: 322-331.
14- Suleiman MO, Ahmed ME. Major lower limb
amputation in diabetics. MD thesis; University of
Khartoum, 2003.
15- Ford ES, Malarcher AM, Herman WH et al.
Diabetes mellitus and cigarette smoking: Findings
from the 1989 National Health Interview Survey.
Diabetes Care 1994; 17: 688-92.
16- Bronnum H, Juel K. Abstention from smoking
extends life and compresses morbidity: a
population based study of health expectancy
among smokers and never smokers in Denmark.
Tob Control 2001; 10: 273-78.
17- Boyko EJ, Ahroni JH, Stensel V et al. A
prospective study of risk factors for diabetic foot
ulcer. Diabetes Care 1999; 22: 1036-42.
18- Wakabayashi I, Wakabayashi RK, Masuda H.
Relation of drinking alcohol to atherosclerosis
risk in type 2 diabetes. Diabetes Care 2002; 25: