目的:糖尿病患者下肢截肢(LLA)的危险因素研究不足。我们研究了人口统计学和社会经济,2/医疗,和3/生活方式危险因素可能与新诊断的糖尿病患者的LLA相关。
方法:使用2007年至2016年的瑞典国家糖尿病注册,我们确定了所有≥18岁的糖尿病患者,以前没有截肢。这些人从糖尿病诊断到截肢,移民,死亡,或在2017年研究结束时使用来自住院患者登记册和总人口登记册的数据。该队列由66,569名个体组成。有关人口统计的信息,社会经济,medical,和生活方式的危险因素被确定在第一次记录的糖尿病诊断的时间,从上述寄存器派生。Cox比例风险模型用于获得具有95%置信区间(CI)的风险比(HR)。
结果:在4年的中位随访时间内,有133个人患有LLA。对所有变量进行调整的模型显示,随着年龄的增长,LLA的风险更高,HR1.08(95%CI1.05-1.10),男性,HR1.57(1.06-2.34),离婚了,HR1.67(1.07-2.60),吸烟者HR1.99(1.28-3.09),胰岛素治疗者HR2.03(1.10-3.74),低体力活动(PA)HR2.05(1.10-3.74)的人,和基线HR>4.12时足部风险增加的人。肥胖的人风险较低,HR0.46(0.29-0.75)。
结论:这项研究发现,年龄较大的人群患LLA的风险更高,男性,他们离婚了,有较高的足部风险组,正在接受胰岛素治疗,PA水平较低,和吸烟者。LLA的风险与教育水平之间没有显着关联,原产国,糖尿病的类型,血糖水平,高血压,高脂血症,肌酐水平,或肾小球滤过率。肥胖与LLA风险较低相关。确定的变量可能在糖尿病患者的LLA风险中起重要作用。
OBJECTIVE: Risk factors for lower limb amputation (LLA) in individuals with diabetes have been under-studied. We examined how 1/demographic and socioeconomic, 2/medical, and 3/lifestyle risk factors may be associated with LLA in people with newly diagnosed diabetes.
METHODS: Using the Swedish national diabetes register from 2007 to 2016, we identified all individuals ≥18 years with an incident diabetes diagnosis and no previous amputation. These individuals were followed from the date of diabetes diagnosis to amputation, emigration, death, or the end of the
study in 2017 using data from the In-Patient Register and the Total Population Register. The cohort consisted of 66,569 individuals. Information about demographic, socioeconomic, medical, and lifestyle risk factors was ascertained around the time of the first recorded diabetes diagnosis, derived from the above-mentioned registers. Cox proportional hazard models were used to obtain hazard ratios (HR) with 95% confidence intervals (CI).
RESULTS: During the median follow-up time of 4 years, there were 133 individuals with LLA. The model adjusting for all variables showed a higher risk for LLA with higher age, HR 1.08 (95% CI 1.05-1.10), male sex, HR 1.57 (1.06-2.34), being divorced, HR 1.67 (1.07-2.60), smokers HR 1.99 (1.28-3.09), insulin treated persons HR 2.03 (1.10-3.74), people with low physical activity (PA) HR 2.05 (1.10-3.74), and people with an increased foot risk at baseline HR > 4.12. People with obesity had lower risk, HR 0.46 (0.29-0.75).
CONCLUSIONS: This
study found a higher risk for LLA among people with higher age, male sex, who were divorced, had a higher foot risk group, were on insulin treatment, had lower PA levels, and were smokers. No significant association was found between risk for LLA and education level, country of origin, type of diabetes, blood glucose level, hypertension, hyperlipidemia, creatinine level, or glomerular filtration rate. Obesity was associated with lower risk for LLA. Identified variables may have important roles in LLA risk among people with diabetes.