Lower extremity amputations (LEA) are associated with a high mortality and medical expenditure. Diabetes accounts for 45% to 70% of LEA and is one of the most potent risk factors for peripheral artery diseases (PAD). The existence of a link between the recent relaxation of glycemic targets and the resurgence of LEA is suggested from the analysis of adult participants in the National Health and Nutrition Examination Survey (NHANES) between 2010 and 2015, when diabetes-related LEA increased by more than 25% associated with a decline in glycemic control. Indeed, in “the perfect wave” of NHANES, including the years 2007–2010, there was the highest number of diabetic people with hemoglobin A1c (HbA1c), non-high-density lipoprotein (HDL) cholesterol and blood pressure levels at their respective targets, associated with the lowest number of LEA. Until now, the ACCORD study, testing the role of aggressive vs conventional glucose control, and the LEADER trial, evaluating the effects of liraglutide versus placebo, have shown a reduced incidence of LEA in people with type 2 diabetes. The results of ongoing clinical trials involving glucagon-like peptide-1 receptor agonists (GLP-1RA, liraglutide or semaglutide) hopefully will tell us whether the wider use of these drugs may provide additional vascular benefits for diabetic people affected by PAD to decrease their risk of LEA.

中文翻译：

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糖尿病患者的血糖控制和下肢截肢的上升和下降波

下肢截肢 (LEA) 与高死亡率和医疗支出有关。糖尿病占 LEA 的 45% 至 70%，是外周动脉疾病 (PAD) 最有效的危险因素之一。对 2010 年至 2015 年国家健康和营养检查调查 (NHANES) 中成年参与者的分析表明，最近的血糖目标放宽与 LEA 重新抬头之间存在联系，当时与糖尿病相关的 LEA 增加了超过25% 与血糖控制下降有关。事实上，在 NHANES 的“完美浪潮”中，包括 2007-2010 年，血红蛋白 A1c (HbA1c)、非高密度脂蛋白 (HDL) 胆固醇和血压水平分别为目标，与最低数量的 LEA 相关联。迄今为止，ACCORD 研究（测试积极控制与传统血糖控制的作用）和 LEADER 试验（评估利拉鲁肽与安慰剂的作用）均显示 2 型糖尿病患者 LEA 发生率降低。正在进行的涉及胰高血糖素样肽-1 受体激动剂（GLP-1RA、利拉鲁肽或司马鲁肽）的临床试验的结果有望告诉我们，更广泛地使用这些药物是否可以为受 PAD 影响的糖尿病患者提供额外的血管益处，以降低他们的风险LEA 的。