1008 — The Association Between Obesity and Charcot Arthropathy in a Diabetic Population

Budiman-Mak E (Center for Management of Complex Chronic Care (CMC3)), Sohn M (CMC3), Stuck RM (Hines VA Hospital), Lee TA (CMC3), Weiss KB (CMC3)

Objectives:
To examine the association of obesity, peripheral neuropathy (PN), and peripheral vascular disease (PVD) with the Charcot arthropathy incidence rate in a large diabetic population.

Methods:
The Department of Veterans Affairs (VA) inpatient and outpatient administrative datasets were used to identify veterans with diabetes in 2003. Logistic regressions were used to model the likelihood of a veteran developing Charcot arthropathy as a function of individual characteristics, obesity, PN, PVD, diabetic control, and co-morbidities.

Results:
Of VA users with diabetes, 652 (0.12%) were newly diagnosed with Charcot arthropathy in 2003. Compared to patients without obesity, PN, or PVD, those with obesity alone were about 57% more likely and those with PN alone were 14 times more likely to develop it. Patients with both obesity and PN were 21 times more likely and those with obesity, PN and PVD were 34 times more likely to develop it. For obese patients with both PN and PVD, a reduction in body mass index by five units was associated with over 0.11% decrease in the absolute risk.

Implications:
Obesity was significantly associated with increased incidence of Charcot arthropathy, independent of other risk factors. When obesity combines with PN and PVD, its incidence rate increased multiplicatively. Prevention and detection of Charcot arthropathy should take these disease-disease interactions into consideration. Weight reduction is frequently the only modifiable risk factor in this population and can provide a dramatic reduction in the observed incidence of Charcot arthropathy.

Impacts:
VHA primary care physicians can use the results of this study for prevention and early detection of Charcot arthropathy. Patients with unexplained foot and ankle edema will obtain limb protection and vigilant assessment for Charcot arthropathy development. This recommendation is especially critical for obese patients with peripheral neuropathy and PVD. Through increased surveillance of this group with elevated risk, the diabetic population may experience better control of diabetes, a general reduction in the prevalence of Charcot arthropathy, and a reduced rate of amputation for this limb-threatening condition.