Risk factors and incidence over time for lower extremity amputations in people with type 1 diabetes: an observational cohort study of 46,088 patients from the Swedish National Diabetes Registry,Diabetologia

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Risk factors and incidence over time for lower extremity amputations in people with type 1 diabetes: an observational cohort study of 46,088 patients from the Swedish National Diabetes Registry
Diabetologia ( IF 8.4 ) Pub Date : 2021-09-08 , DOI: 10.1007/s00125-021-05550-z
Sara Hallström _{1,

2} , Ann-Marie Svensson _{2,

3} , Aldina Pivodic _{4,

5} , Arndís F Ólafsdóttir _{2,

6} , Magnus Löndahl _{7,

8} , Hans Wedel ₉ , Marcus Lind _{2,

6}

Affiliation

Aims/hypothesis

The aim of this work was to study the incidence over time of lower extremity amputations and determine variables associated with increased risk of amputations in people with type 1 diabetes.

Methods

Individuals with type 1 diabetes registered in the Swedish National Diabetes Registry with no previous amputation from 1 January 1998 and followed to 2 October 2019 were included. Time-updated Cox regression and gradient of risk per SD were used to evaluate the impact of risk factors on the incidence of amputation. Age- and sex-adjusted incidences were estimated over time.

Results

Of 46,088 people with type 1 diabetes with no previous amputation (mean age 32.5 years [SD 14.5], 25,354 [55%] male sex), 1519 (3.3%) underwent amputation. Median follow-up was 12.4 years. The standardised incidence for any amputation in 1998–2001 was 2.84 (95% CI 2.32, 3.36) per 1000 person-years and decreased to 1.64 (95% CI 1.38, 1.90) per 1000 person-years in 2017–2019. The incidence for minor and major amputations showed a similar pattern. Hyperglycaemia and renal dysfunction were the strongest risk factors for amputation, followed by older age, male sex, cardiovascular comorbidities, smoking and hypertension. Glycaemic control and age- and sex-adjusted renal function improved during the corresponding time period as amputations decreased.

Conclusions/interpretation

The incidence of amputation and of the most prominent risk factors for amputation, including renal dysfunction and hyperglycaemia, has improved considerably during recent years for people with type 1 diabetes. This finding has important implications for quality of life, health economics and prognosis regarding CVD, indicating a trend shift in the treatment of type 1 diabetes.

Graphical abstract

中文翻译：

1 型糖尿病患者下肢截肢的风险因素和发病率随时间变化：一项针对瑞典国家糖尿病登记处 46,088 名患者的观察性队列研究

目标/假设

这项工作的目的是研究随着时间的推移下肢截肢的发病率，并确定与 1 型糖尿病患者截肢风险增加相关的变量。

方法

纳入在瑞典国家糖尿病登记处登记的 1998 年 1 月 1 日至 2019 年 10 月 2 日之前没有截肢的 1 型糖尿病患者。使用时间更新的 Cox 回归和每个 SD 的风险梯度来评估风险因素对截肢发生率的影响。随着时间的推移，估计了年龄和性别调整后的发病率。

结果

在 46,088 名没有截肢的 1 型糖尿病患者中（平均年龄 32.5 岁 [SD 14.5]，25,354 [55%] 男性），1519 (3.3%) 人接受了截肢。中位随访时间为 12.4 年。1998-2001 年任何截肢的标准化发病率为每 1000 人年 2.84（95% CI 2.32, 3.36），并在 2017-2019 年降至每 1000 人年 1.64（95% CI 1.38, 1.90）。小截肢和大截肢的发生率显示出类似的模式。高血糖和肾功能不全是截肢的最大危险因素，其次是高龄、男性、心血管合并症、吸烟和高血压。随着截肢次数的减少，血糖控制和年龄和性别调整后的肾功能在相应的时间段内得到改善。