Excess risk of lower extremity amputations in people with type 1 diabetes compared with the general population: amputations and type 1 diabetes

Abstract

ObjectiveThis study investigates how the excess risk of lower extremity amputations (amputations) in people with type 1 diabetes mellitus (DM) differs from the general population by diabetes duration, glycemic control, and renal complications.Research design and methodsWe analyzed data from people with type 1 DM from the Swedish National Diabetes Register without prior amputation from January 1998 to December 2013. Each person (n=36 872) was randomly matched with five controls by sex, age, and county (n=184 360) from the population without diabetes. All were followed until first amputation, death or end of follow-up.ResultsThe overall adjusted HR for all amputation was 40.1 (95% CI 32.8 to 49.1) for type 1 DM versus controls. HR increased with longer diabetes duration. The incidence of amputation/1000 patient-years was 3.18 (95% CI 2.99 to 3.38) for type 1 DM and 0.07 (95% CI 0.05 to 0.08) for controls. The incidence decreased from 1998–2001 (3.09, 95% CI 2.56 to 3.62) to 2011–2013 (2.64, 95% CI 2.31 to 2.98). The HR for major amputations was lower than for minor amputations and decreased over the time period (p=0.0045). Worsening in glycemic control among patients with diabetes led to increased risk for amputation with an HR of 1.80 (95% CI 1.72 to 1.88) per 10 mmol/mol (1%) increase in hemoglobin A1c.ConclusionsAlthough the absolute risk of amputation is relatively low, the overall excess risk was 40 times that of controls. Excess risk was substantially lower for those with good glycemic control and without renal complications, but excess risk still existed and is greatest for minor amputations.

Risk factors and incidence over time for lower extremity amputations in people with type 1 diabetes: an observational cohort study of 46,088 patients from the Swedish National Diabetes Registry

“…In previous evaluations of incidences of LEA over time no clear reductions were found until 2013, when a 40-fold excess risk compared with the general population was reported [ 5 ]. We found that amputation decreased significantly over time, especially from 2014 onwards, along with improved glycaemic control and fewer renal complications.…”

“…Lower extremity amputation (LEA) in people with diabetes is a major source of disability and distress and constitutes a significant financial burden for the healthcare system [2][3][4]. About half of all non-traumatic amputations in the western world are attributable to diabetes, and an earlier study showed a 40-fold excess risk of amputations in people with type 1 diabetes compared with the general population [5].…”

Hybrid closed-loop glucose control compared with sensor augmented pump therapy in older adults with type 1 diabetes: an open-label multicentre, multinational, randomised, crossover study

“…The prevalence of diabetes related complications and other significant comorbidities also rises with increasing age and duration of diabetes, with older adults having the highest rates of major lower-extremity amputation, cardiovascular events, visual impairment, and end-stage renal disease in addition to potential problems with hearing, dexterity, mobility, and cognition. [4][5][6][7] Although recommended glycaemic targets are different for older adults with type 1 diabetes, with emphasis on minimising hypoglycaemia, 8 older adults remain at risk of developing the vascular complications associated with suboptimal glycaemic control. Many older adults wish to pursue the standard recommended targets to avoid complications associated with persistent hyperglycaemia.…”

Renal Complications and Duration of Diabetes: An International Comparison in Persons with Type 1 Diabetes

“…More focused treatments for renal complications are needed to an even greater extent since many T1D patients continue to develop renal complications. Early signs of renal complications are associated with not only future renal progression but also greater risk for myocardial infarction, heart failure, amputations and shorter life expectancy [5][6][7][8]30]. Improving glycaemic control is critical to preventing renal complications; thus, glycaemic control strategies need to be focused, including CGM for MDI treated patients and in conjunction with insulin pumps [13,14,31].…”