Icks A, Haastert B, Trautner C, Giani G, Glaeske G, Hoffmann F
Institute of Biometrics and Epidemiology, German Diabetes Center at the Heinrich-Heine-University, Leibniz-Center for Diabetes Research, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany.
Exp Clin Endocrinol Diabetes. 2009 Oct;117(9):500-4. doi: 10.1055/s-0029-1225333. Epub 2009 Jul 23.
One major objective is to reduce the risk of lower limb amputation in diabetes mellitus. Nationwide data to incidences of amputations in the diabetic and non-diabetic populations in Germany as well as relative and attributable risks due to diabetes are lacking so far.
Using data of a nationwide statutory health insurance (1.6 million members), we assessed all first non-traumatic lower-limb amputations between 2005 and 2007. We estimated sex-age-specific and standardized incidences of amputations in the diabetic and non-diabetic populations, and relative and attributable risks due to diabetes.
Of all subjects with a first amputation in the study period 2005-2007 (n=994), 66% had diabetes, 76% were male, mean age (SD) was 67 (13) years. Incidences per 100 000 person years (standardized to the 2004 German population) in the diabetic and the non-diabetic populations: 176.5 (95% confidence interval 156.0-196.9) and 20.0 (17.0-23.1) in men, and 76.9 (61.9-91.8) and 13.4 (10.7-16.2) in women. Standardized relative risks: 8.8 (7.3-10.7) in men and 5.7 (4.3-7.6) in women. Attributable risks among exposed: 0.89 and 0.83 and population attributable risks 0.59 and 0.40, each in men and women, respectively.
In our first German nationwide study, we found the relative risk of lower limb amputation in the diabetic compared to the non-diabetic to be lower than in earlier regional studies in Germany, supporting results of regional reductions of the excess amputation risk due to diabetes. A repetition of the study is warranted to further evaluate trends according to the St. Vincent goals.
一个主要目标是降低糖尿病患者下肢截肢的风险。目前德国缺乏关于糖尿病患者和非糖尿病患者截肢发生率以及糖尿病所致相对风险和归因风险的全国性数据。
利用全国法定健康保险（160万成员）的数据，我们评估了2005年至2007年期间所有首次非创伤性下肢截肢情况。我们估计了糖尿病患者和非糖尿病患者按性别和年龄划分的以及标准化的截肢发生率，以及糖尿病所致相对风险和归因风险。
在2005 - 2007年研究期间首次截肢的所有受试者（n = 994）中，66%患有糖尿病，76%为男性，平均年龄（标准差）为67（13）岁。糖尿病患者和非糖尿病患者每10万人年的发生率（标准化为2004年德国人口）：男性分别为176.5（95%置信区间156.0 - 196.9）和20.0（17.0 - 23.1），女性分别为76.9（61.9 - 91.8）和13.4（10.7 - 16.2）。标准化相对风险：男性为8.8（7.3 - 10.7），女性为5.7（4.3 - 7.6）。暴露者的归因风险：男性和女性分别为0.89和0.83，人群归因风险分别为0.59和0.40。
在我们德国的首次全国性研究中，我们发现糖尿病患者与非糖尿病患者相比下肢截肢的相对风险低于德国早期的地区性研究，这支持了因糖尿病导致的额外截肢风险在地区层面有所降低的结果。有必要重复该研究以根据圣文森特目标进一步评估趋势。
