Gyldenkerne Christine, Olesen Kevin K W, Thrane Pernille G, Hansen Malene K, Stødkilde-Jørgensen Nina, Sørensen Henrik T, Thomsen Reimar W, Maeng Michael
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
Diabetes Care. 2025 Jan 1;48(1):76-83. doi: 10.2337/dc24-1644.
To examine trends in peripheral artery disease (PAD), lower-extremity (LE) revascularization, and LE amputation in patients with incident type 2 diabetes.
This cohort study included patients in Denmark diagnosed with type 2 diabetes in 1996-2015 and followed until 2020. Patients were age and sex matched with as many as three general population individuals. Outcomes comprised 5-year cumulative incidences of first-time PAD, LE revascularization, and LE amputation. Age- and sex-adjusted hazard ratios (aHRs) were computed using Cox regression.
The cohort comprised 349,454 patients with incident type 2 diabetes (53% male; median age 62 years) and 1,025,054 general population individuals. Among patients with diabetes, decreases in 5-year cumulative incidence of PAD (from 6.2 to 3.4%; aHR 0.55 [95% CI 0.52-0.57]), LE revascularization (from 0.8 to 0.6%; aHR 0.80 [95% CI 0.71-0.90]), and LE amputation (from 1.0 to 0.4%; aHR 0.45 [95% CI 0.40-0.51]) occurred from 1996-2000 to 2011-2015. LE amputation decreased at all amputation levels (hip/thigh, knee/lower leg, and ankle/foot/toe) during the study period. In the general population, 5-year cumulative incidence remained stable (1.2-1.5% for PAD, ∼0.4% for LE revascularization, and ∼0.2% for LE amputation). However, the relative rates of all outcomes were two- to threefold higher in patients with diabetes than matched individuals in 2011-2015.
In recent decades, the cumulative incidence of LE complications substantially decreased in patients with incident type 2 diabetes while remaining stable in the general population.
研究初发2型糖尿病患者外周动脉疾病（PAD）、下肢（LE）血管重建术及LE截肢的趋势。
这项队列研究纳入了1996年至2015年在丹麦被诊断为2型糖尿病且随访至2020年的患者。患者在年龄和性别上与多达三名普通人群个体相匹配。结局包括首次发生PAD、LE血管重建术及LE截肢的5年累积发病率。使用Cox回归计算年龄和性别调整后的风险比（aHRs）。
该队列包括349,454例初发2型糖尿病患者（男性占53%；中位年龄62岁）和1,025,054名普通人群个体。在糖尿病患者中，从1996 - 2000年到2011 - 2015年，PAD的5年累积发病率下降（从6.2%降至3.4%；aHR 0.55 [95%CI 0.52 - 0.57]），LE血管重建术（从0.8%降至0.6%；aHR 0.80 [95%CI 0.71 - 0.90]），以及LE截肢（从1.0%降至0.4%；aHR 0.45 [95%CI 0.40 - 0.51]）。在研究期间，所有截肢水平（髋部/大腿、膝部/小腿和踝部/足部/脚趾）的LE截肢率均下降。在普通人群中，5年累积发病率保持稳定（PAD为1.2% - 1.5%，LE血管重建术约为0.4%，LE截肢约为0.2%）。然而，在2011 - 2015年，糖尿病患者所有结局的相对发生率比匹配个体高两到三倍。
近几十年来，初发2型糖尿病患者LE并发症的累积发病率大幅下降，而普通人群中保持稳定。
