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

Hallström, Sara; Svensson, Ann‐Marie; Pivodic, Aldina; Ólafsdóttir, Arndís F.; Löndahl, Magnus; Wedel, Hans; Lind, Marcus

doi:10.1007/s00125-021-05550-z

Cited by 16 publications

(16 citation statements)

References 32 publications

(53 reference statements)

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“…The results of the present study are in line with those found in the literature, namely, an increasing male predominance in minor and major LEAs [ 2 , 4 , 6 , 21 ]. Similar sex differences were reported in a study conducted using data from the IBM Market-Scan research database among patients with T1DM and T2DM [ 22 ].…”

Section: Discussionsupporting

confidence: 93%

“…However, for minor LEA the incidence increased, albeit not significantly, between 2010 and 2019. These findings have been reported elsewhere in Europe [ 4 , 7 ]. In a population-based cohort study in Sweden, Hallstrom et al [ 4 ] found that the frequency of amputation in patients with T1DM decreased between 1998 and 2019 and concluded that these changes are possibly related to an increased focus on risk factor management, advanced treatments to optimise glycaemic control, and further enhancements in the armamentarium of multidisciplinary diabetes foot clinics, including an increased use of invasive arterial reperfusion.…”

Section: Discussionsupporting

confidence: 91%

“…While the results of the present study indicate that hypertension decreased over time, the frequency of chronic kidney disease and lipid metabolism disorders increased in patients who underwent minor and major LEA. The association between LEA and person-level risk factors in individuals with T1DM has been studied elsewhere [ 2 , 4 , 22 , 25 ]. Hallstrom et al [ 4 ] recently described cardiovascular comorbidities, renal dysfunction, increased HbA1c, hypertension, and smoking to be associated with an increased risk of amputation in patients with T1DM.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study showed a 40-fold greater risk of amputation in patients with T1DM than in the general population [ 3 ]. The risk of LEA in patients with T1DM is a result of the combination of several conditions whose key contributing factors include ageing, male sex, cardiovascular comorbidities, hyperglycaemia, hypertension, and hyperlipidaemia [ 2 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Population-based studies in Spain showed that the number of T1DM-related LEAs decreased between 2001 and 2008 and then remained stable through 2012 [ 5 , 6 ]. A Swedish study also reported a decrease in the frequency of amputations in patients with T1DM between 2017 and 2019 [ 4 ]. Similar findings have been reported in Denmark [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Time trends (2001–2019) and sex differences in incidence and in-hospital mortality after lower extremity amputations among patients with type 1 diabetes in Spain

López‐de‐Andrés

Jiménez‐García

Hernández‐Barrera

et al. 2022

Cardiovasc Diabetol

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Background We examined trends in incidence (2001–2019), clinical characteristics, and in-hospital outcomes following major and minor lower extremity amputations (LEAs) among type 1 diabetes mellitus (T1DM) patients in Spain and attempted to identify sex differences. Methods Retrospective cohort study using data from the Spanish National Hospital Discharge Database. We estimated the incidence of the LEA procedure stratified by type of LEA. Joinpoint regression was used to estimate incidence trends, and logistic regression was used to estimate factors associated with in-hospital mortality (IHM). Results LEA was coded in 6011 patients with T1DM (66.4% minor and 33.6% major). The incidence of minor LEA decreased by 9.55% per year from 2001 to 2009 and then increased by 1.50% per year, although not significantly, through 2019. The incidence of major LEA decreased by 13.39% per year from 2001 to 2010 and then remained stable through 2019. However, incidence increased in men (26.53% per year), although not significantly, from 2017 to 2019. The adjusted incidence of minor and major LEA was higher in men than in women (IRR 3.01 [95% CI 2.64–3.36] and IRR 1.85 [95% CI 1.31–2.38], respectively). Over the entire period, for those who underwent a minor LEA, the IHM was 1.58% (2.28% for females and 1.36% for males; p = 0.045) and for a major LEA the IHM was 8.57% (10.52% for females and 7.59% for males; p = 0.025). IHM after minor and major LEA increased with age and the presence of comorbid conditions such as peripheral arterial disease, ischemic heart disease or chronic kidney disease. Female sex was associated with a higher IHM after major LEA (OR 1.37 [95% CI 1.01–1.84]). Conclusions Our data show a decrease in incidence rates for minor and major LEA in men and women with T1DM and a slight, albeit insignificant, increase in major LEA in men with T1DM in the last two years of the study. The incidence of minor and major LEA was higher in men than in women. Female sex is a predictor of IHM in patients with T1DM following major LEA.

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