Yu Jin, Kim Ji-Hyun, Kim Bongseong, Han Kyungdo, Lee Seung Hwan, Kim Mee Kyoung
Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
Endocrinol Metab (Seoul). 2025 Aug;40(4):574-582. doi: 10.3803/EnM.2024.2266. Epub 2025 Apr 15.
This study aimed to assess whether markers of diabetes severity could serve as predictors for foot amputation risk among patients with type 2 diabetes mellitus.
We analyzed data from the nationally representative Korean National Health Insurance System database, tracking 2,544,077 patients with type 2 diabetes mellitus who participated in routine health check-ups between 2009 and 2012, with followup extending through the end of 2018. The parameters used to define the diabetes severity score encompassed diabetes duration, insulin usage, the number of oral glucose-lowering medications, the presence of chronic kidney disease, diabetic retinopathy, and cardiovascular disease. Each factor was assigned one point, yielding a cumulative severity score ranging from 0 to 6.
The risk of diabetic foot amputation was predominantly predicted by insulin therapy, diabetic retinopathy, and a prolonged duration of diabetes. The hazard ratios for foot amputation increased with the severity score as follows: 2.31 (95% confidence interval [CI], 2.15 to 2.47) for a score of 1, 4.73 (95% CI, 4.42 to 5.07) for a score of 2, 8.86 (95% CI, 8.24 to 9.53) for a score of 3, 16.95 (95% CI, 15.60 to 18.4) for a score of 4, 23.98 (95% CI, 21.25 to 27.05) for a score of 5, and 37.87 (95% CI, 28.93 to 49.57) for a score of 6.
Specific markers of advanced diabetes effectively identified patients at an elevated risk for diabetic foot amputation.
本研究旨在评估糖尿病严重程度标志物是否可作为2型糖尿病患者足部截肢风险的预测指标。
我们分析了具有全国代表性的韩国国民健康保险系统数据库中的数据，追踪了2009年至2012年期间参加常规健康检查的2544077例2型糖尿病患者，随访至2018年底。用于定义糖尿病严重程度评分的参数包括糖尿病病程、胰岛素使用情况、口服降糖药数量、慢性肾病、糖尿病视网膜病变和心血管疾病的存在情况。每个因素赋予1分，得出累积严重程度评分范围为0至6分。
糖尿病足截肢风险主要由胰岛素治疗、糖尿病视网膜病变和糖尿病病程延长预测。足部截肢的风险比随严重程度评分增加如下：评分为1分时为2.31（95%置信区间[CI]，2.15至2.47），评分为2分时为4.73（95%CI，4.42至5.07），评分为3分时为8.86（95%CI，8.24至9.53），评分为4分时为16.95（95%CI，15.60至18.4），评分为5分时为23.98（95%CI，21.25至27.05），评分为6分时为37.87（95%CI，28.93至49.57）。
晚期糖尿病的特定标志物可有效识别糖尿病足截肢风险升高的患者。
