Background: Diabetes Mellitus (DM) and its complications are well studied; patients with
diabetes may suffer from neuropathy and vascular issues, and associated with these, lower extremity
ulceration. Ulcers are often refractory to treatment, and can be difficult for both patients and clinicians
to manage. Such complications may lead to amputations, which in turn are a risk factor for death.
However, in certain situations amputation may be the only option available, and may be used as reconstructive
surgery, restoring function. The impacts of ulceration, amputation, use of prostheses, and
other complications of diabetes on Quality of Life (QOL) are well studied. Similarly, the impact of
QOL on overall health has been studied in some detail.
Objective: Not as well understood are patient expectations regarding amputation and ulceration, and
patient knowledge of these outcomes. Specifically, it is not fully understood how patients view these
complications prior to their occurrence. In this review we survey the literature for studies discussing
these attitudes. Our objective was to perform a systematic review of the medical literature to understand
how patients understand and anticipate the potential negative outcomes of ulceration and amputation.
We also aimed to identify areas where there are gaps in patient knowledge, which could be addressed
Results: Our study yielded articles regarding impressions of patients with diabetes about their general
health and outcomes. However, we did not discover much literature directly concerning attitudes toward
catastrophic lower extremity outcomes before they occurred. We also identified that patients lack
knowledge of management and complications of diabetes; both of these gaps provide an opportunity to
better direct care for such patients.