Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden.
J Foot Ankle Res. 2024 Sep;17(3):e70005. doi: 10.1002/jfa2.70005.
Risk factors for lower limb amputation (LLA) in individuals with diabetes have been under-studied. We examined how 1/demographic and socioeconomic, 2/medical, and 3/lifestyle risk factors may be associated with LLA in people with newly diagnosed diabetes.
Using the Swedish national diabetes register from 2007 to 2016, we identified all individuals ≥18 years with an incident diabetes diagnosis and no previous amputation. These individuals were followed from the date of diabetes diagnosis to amputation, emigration, death, or the end of the study in 2017 using data from the In-Patient Register and the Total Population Register. The cohort consisted of 66,569 individuals. Information about demographic, socioeconomic, medical, and lifestyle risk factors was ascertained around the time of the first recorded diabetes diagnosis, derived from the above-mentioned registers. Cox proportional hazard models were used to obtain hazard ratios (HR) with 95% confidence intervals (CI).
During the median follow-up time of 4 years, there were 133 individuals with LLA. The model adjusting for all variables showed a higher risk for LLA with higher age, HR 1.08 (95% CI 1.05-1.10), male sex, HR 1.57 (1.06-2.34), being divorced, HR 1.67 (1.07-2.60), smokers HR 1.99 (1.28-3.09), insulin treated persons HR 2.03 (1.10-3.74), people with low physical activity (PA) HR 2.05 (1.10-3.74), and people with an increased foot risk at baseline HR > 4.12. People with obesity had lower risk, HR 0.46 (0.29-0.75).
This study found a higher risk for LLA among people with higher age, male sex, who were divorced, had a higher foot risk group, were on insulin treatment, had lower PA levels, and were smokers. No significant association was found between risk for LLA and education level, country of origin, type of diabetes, blood glucose level, hypertension, hyperlipidemia, creatinine level, or glomerular filtration rate. Obesity was associated with lower risk for LLA. Identified variables may have important roles in LLA risk among people with diabetes.
下肢截肢（LLA）的风险因素在糖尿病患者中研究较少。我们研究了在新诊断的糖尿病患者中，1/人口统计学和社会经济、2/医疗和 3/生活方式的风险因素如何与 LLA 相关。
我们使用 2007 年至 2016 年的瑞典国家糖尿病登记处，确定了所有年龄≥18 岁、有新发糖尿病诊断且无既往截肢的个体。从糖尿病诊断日期开始，通过住院患者登记处和总人口登记处的数据，对这些个体进行随访，直至截肢、移民、死亡或 2017 年研究结束。队列包括 66569 名个体。围绕首次记录的糖尿病诊断时间，从上述登记处获取人口统计学、社会经济、医疗和生活方式风险因素的信息。使用 Cox 比例风险模型获得危险比（HR）和 95%置信区间（CI）。
在中位 4 年的随访期间，有 133 人发生 LLA。在调整所有变量的模型中，年龄较高、HR 1.08（95%CI 1.05-1.10）、男性、HR 1.57（1.06-2.34）、离婚、HR 1.67（1.07-2.60）、吸烟者 HR 1.99（1.28-3.09）、胰岛素治疗者 HR 2.03（1.10-3.74）、体力活动水平较低者 HR 2.05（1.10-3.74）和基线足部风险较高者 HR>4.12 的人发生 LLA 的风险更高。肥胖者发生 LLA 的风险较低，HR 0.46（0.29-0.75）。
本研究发现，年龄较高、男性、离婚、足部风险较高、接受胰岛素治疗、体力活动水平较低、吸烟的人发生 LLA 的风险更高。LLA 风险与教育水平、原籍国、糖尿病类型、血糖水平、高血压、高血脂、肌酐水平或肾小球滤过率之间无显著相关性。肥胖与 LLA 风险降低相关。确定的变量可能在糖尿病患者的 LLA 风险中发挥重要作用。
