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
(2021) In Diabetologia 64(12). p.2751-2761- Abstract
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], 25,35a4 [55%] male sex), 1519 (3.3%) underwent... (More)
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], 25,35a4 [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: [Figure not available: see fulltext.]
(Less)
- author
- Hallström, Sara ; Svensson, Ann Marie ; Pivodic, Aldina ; Ólafsdóttir, Arndís F. ; Löndahl, Magnus LU ; Wedel, Hans and Lind, Marcus
- organization
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Amputation, Cardiovascular disease, Epidemiology, HbA, Lower-extremity amputation, Risk factors, Type 1 diabetes
- in
- Diabetologia
- volume
- 64
- issue
- 12
- pages
- 2751 - 2761
- publisher
- Springer
- external identifiers
-
- scopus:85114359876
- pmid:34494137
- ISSN
- 0012-186X
- DOI
- 10.1007/s00125-021-05550-z
- language
- English
- LU publication?
- yes
- id
- efbaf35f-192f-4db5-8c7e-0959344d3b47
- date added to LUP
- 2021-10-04 12:16:31
- date last changed
- 2024-04-20 12:18:40
@article{efbaf35f-192f-4db5-8c7e-0959344d3b47,
abstract = {{<p>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], 25,35a4 [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: [Figure not available: see fulltext.]</p>}},
author = {{Hallström, Sara and Svensson, Ann Marie and Pivodic, Aldina and Ólafsdóttir, Arndís F. and Löndahl, Magnus and Wedel, Hans and Lind, Marcus}},
issn = {{0012-186X}},
keywords = {{Amputation; Cardiovascular disease; Epidemiology; HbA; Lower-extremity amputation; Risk factors; Type 1 diabetes}},
language = {{eng}},
number = {{12}},
pages = {{2751--2761}},
publisher = {{Springer}},
series = {{Diabetologia}},
title = {{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}},
url = {{http://dx.doi.org/10.1007/s00125-021-05550-z}},
doi = {{10.1007/s00125-021-05550-z}},
volume = {{64}},
year = {{2021}},
}