Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan.
JMDC Inc., Tokyo, Japan.
J Foot Ankle Res. 2021 Apr 9;14(1):29. doi: 10.1186/s13047-021-00474-8.
The prevalence of diabetes is rising, and diabetes develops at a younger age in East Asia. Although lower limb amputation negatively affects quality of life and increases the risk of cardiovascular events, little is known about the rates and predictors of amputation among persons with diabetes from young adults to those in the "young-old" category (50-72 y).
We analyzed data from a nationwide claims database in Japan accumulated from 2008 to 2016 involving 17,288 people with diabetes aged 18-72 y (mean age 50.2 y, HbA1c 7.2%). Amputation occurrence was determined according to information from the claims database. Cox regression model identified variables related to lower limb amputation.
The mean follow-up time was 5.3 years, during which time 16 amputations occurred (0.17/1000 person-years). Multivariate Cox regression analysis showed that age (hazard ratio [HR] 1.09 [95% confidence intervals] 1.02-1.16, p = 0.01) and HbA1c (HR 1.46 [1.17-1.81], p < 0.01) were independently associated with amputations. Compared with those aged < 60 years with HbA1c < 8.0%, the HR for amputation was 27.81 (6.54-118.23) in those aged ≥60 years and HbA1c ≥8.0%.
Age and HbA1c were associated with amputations among diabetic individuals, and the rates of amputation were significantly greater in those ≥60 years old and with HbA1c ≥8.0%.
糖尿病的患病率正在上升，东亚地区的糖尿病发病年龄也越来越年轻。尽管下肢截肢会降低生活质量并增加心血管事件的风险，但对于年轻成年人到“年轻老年人”（50-72 岁）人群中糖尿病患者的截肢率和预测因素知之甚少。
我们分析了日本一项全国性的索赔数据库中的数据，该数据库于 2008 年至 2016 年期间积累，涉及 17288 名年龄在 18-72 岁（平均年龄 50.2 岁，HbA1c7.2%）的糖尿病患者。根据索赔数据库中的信息确定截肢发生情况。Cox 回归模型确定与下肢截肢相关的变量。
平均随访时间为 5.3 年，在此期间发生了 16 例截肢（0.17/1000 人年）。多变量 Cox 回归分析显示，年龄（风险比 [HR] 1.09 [95%置信区间 1.02-1.16，p=0.01）和 HbA1c（HR 1.46 [1.17-1.81]，p<0.01）与截肢独立相关。与年龄<60 岁且 HbA1c<8.0%的患者相比，年龄≥60 岁且 HbA1c≥8.0%的患者截肢风险为 27.81（6.54-118.23）。
年龄和 HbA1c 与糖尿病患者的截肢有关，年龄≥60 岁且 HbA1c≥8.0%的患者截肢率显著更高。
