Diabetes Centre, Isala, 8025 BP Zwolle, The Netherlands; Innofeet, 8013 PH Zwolle, The Netherlands; Department of Internal Medicine, University Medical Centre Groningen, 9700 RB Groningen, and Groningen University, The Netherlands.
Diabetes Centre, Isala, 8025 BP Zwolle, The Netherlands; Department of Endocrinology, University Medical Centre Groningen, 9700 AB Groningen, The Netherlands; Department of Internal Medicine, University Medical Centre Groningen, 9700 RB Groningen, and Groningen University, The Netherlands.
Eur J Vasc Endovasc Surg. 2023 Aug;66(2):229-236. doi: 10.1016/j.ejvs.2023.05.030. Epub 2023 May 21.
Lower extremity amputations are a major complication of diabetes mellitus (DM). In a previous Dutch study, the incident rate of major amputations was 89.2 per 100 000 person years. The primary aim of this study was to describe the lower extremity amputation rates in people with DM in the Zwolle region, where preventive and curative footcare is organised according to the guidelines of the International Working Group of the Diabetic Foot (IWGDF). The secondary aim was to evaluate outcomes and underlying characteristics of these people.
This was a retrospective regional population based cohort study. Data from all people with DM treated in primary and secondary care, living in the region Zwolle were collected. All amputations in the period 2017 to 2019 were analysed. Comparisons were made between those with and without an amputation.
In the analysis 5 915 people with DM were included, with a mean age of 67.8 (IQR 57.9, 75.9) years. Of those people, 47% were women and the median HbA1c was 53 (IQR 47, 62) mmol/mol. Over the three year study period 68 amputations were performed in 59 people: 46 minor, 22 major. This translated into an average annual crude amputation incidence rate of non-traumatic major and minor amputations of 41.5 and 86.9 per 100 000 person years among people with diabetes. Compared with those not undergoing amputations, those who underwent an amputation were more often men, older, mainly had T2DM, were treated in secondary care, had higher diastolic blood pressure, worse diabetic footcare profile, longer DM duration and higher HbA1c. At the end of the follow up, 111 people died: 96 (1.6%) without and 15 (25.4%) with amputations (p < .001).
This retrospective study provides detailed insight into the rate of amputations in Dutch people with diabetes in the region Zwolle. Compared with previous Dutch estimates, these data suggest a considerable decrease in the major amputation incidence rate.
下肢截肢是糖尿病（DM）的主要并发症。在之前的荷兰研究中，主要截肢的发生率为每 100000 人年 89.2 例。本研究的主要目的是描述在遵循国际糖尿病足工作组（IWGDF）指南进行预防性和治疗性足部护理的 Zwolle 地区糖尿病患者的下肢截肢率。次要目的是评估这些患者的结局和潜在特征。
这是一项回顾性的区域性人群队列研究。收集了在初级和二级保健机构接受治疗、居住在 Zwolle 地区的所有糖尿病患者的数据。对 2017 年至 2019 年期间的所有截肢进行了分析。比较了有截肢和无截肢患者之间的差异。
在分析中纳入了 5915 名糖尿病患者，平均年龄为 67.8（IQR 57.9，75.9）岁。其中 47%为女性，中位 HbA1c 为 53（IQR 47，62）mmol/mol。在三年的研究期间，59 名患者进行了 68 例截肢：46 例为小截肢，22 例为大截肢。这相当于每年非创伤性大截肢和小截肢的粗发生率分别为 41.5 和 86.9/100000 人年。与未接受截肢的患者相比，接受截肢的患者更多为男性、年龄更大、主要患有 2 型糖尿病、在二级保健机构接受治疗、舒张压更高、糖尿病足护理状况更差、糖尿病病程更长、HbA1c 更高。在随访结束时，有 111 人死亡：96 人（1.6%）无截肢，15 人（25.4%）有截肢（p<0.001）。
本回顾性研究详细了解了 Zwolle 地区荷兰糖尿病患者的截肢率。与之前的荷兰估计相比，这些数据表明主要截肢发生率显著下降。
