Humphrey A R, Dowse G K, Thoma K, Zimmet P Z
International Diabetes Institute, Melbourne, Australia.
Diabetes Care. 1996 Jul;19(7):710-4. doi: 10.2337/diacare.19.7.710.
To measure the 12-year incidence (1982-1994) of nontraumatic lower extremity amputations (LEAs) in Nauruans, a population at high risk for NIDDM, and to determine the risk factors for amputation in Nauruans with diabetes.
Amputation data were abstracted from operating theater records in Nauru, hospital databases in Australia, and Nauru government records. Baseline characteristics of a cohort of 1,564 Nauruans aged > or = 20 years examined during a population-based survey in 1982 were used to determine risk factors for first LEAs.
Over this 12-year period, 46 first LEAs were performed on people with NIDDM, of whom 30 were members of the 1982 study cohort. The incidence of first LEAs in Nauruans aged > or = 25 years with NIDDM was 8.1 per 1,000 person-years in the study cohort and an estimated 7.6 per 1,000 person-years nationally. Amputations were associated significantly with lower BMI, lower blood pressure, higher fasting plasma glucose (FPG) level, and longer mean duration of diabetes at baseline, but levels of other risk factors, including cigarette smoking, plasma triglycerides, and plasma cholesterol, were also elevated in amputees. There were no amputations among individuals with baseline FPG levels < 7.8 mmol/l, irrespective of diabetes duration. FPG, baseline diabetes duration, and male sex were independent risk factors for first amputation using the Cox proportional hazards model. There was a decrease in the incidence of amputations after the commencement of a national foot care health education and prevention campaign in June 1992.
The incidence of LEAs in diabetic Nauruans was higher than in other populations after adjusting for age and duration. Given the apparent success of the Nauruan footcare program in reducing amputation rates, other populations with high rates of NIDDM and LEAs should consider population-wide prevention strategies.
测量瑙鲁人（2型糖尿病高危人群）非创伤性下肢截肢（LEA）的12年发病率（1982 - 1994年），并确定瑙鲁糖尿病患者截肢的危险因素。
截肢数据取自瑙鲁手术室记录、澳大利亚医院数据库以及瑙鲁政府记录。1982年一项基于人群的调查中对1564名年龄≥20岁的瑙鲁人进行了检查，其基线特征用于确定首次LEA的危险因素。
在这12年期间，对2型糖尿病患者进行了46例首次LEA手术，其中30例是1982年研究队列的成员。研究队列中年龄≥25岁的瑙鲁2型糖尿病患者首次LEA发病率为每1000人年8.1例，全国估计为每1000人年7.6例。截肢与基线时较低的体重指数、较低的血压、较高的空腹血糖（FPG）水平以及较长的糖尿病平均病程显著相关，但截肢者中其他危险因素水平也有所升高，包括吸烟、血浆甘油三酯和血浆胆固醇。基线FPG水平<7.8 mmol/l的个体中无截肢病例，无论糖尿病病程长短。使用Cox比例风险模型，FPG、基线糖尿病病程和男性性别是首次截肢的独立危险因素。1992年6月开展全国足部护理健康教育和预防运动后，截肢发病率有所下降。
调整年龄和病程后，瑙鲁糖尿病患者的LEA发病率高于其他人群。鉴于瑙鲁足部护理项目在降低截肢率方面取得的明显成功，其他2型糖尿病和LEA发病率高的人群应考虑采取全人群预防策略。
