Rates and risk factors for amputation in people with diabetes in Japan: a historical cohort study using a nationwide claims database.
Adolescent
Adult
Age Factors
Aged
Amputation, Surgical
/ statistics & numerical data
Cohort Studies
Databases, Factual
Diabetic Foot
/ blood
Female
Glycated Hemoglobin
/ analysis
Humans
Incidence
Japan
/ epidemiology
Male
Middle Aged
Proportional Hazards Models
Regression Analysis
Risk Factors
Young Adult
Age
Asian people
HbA1c
Lower limb amputation
Risk factor
Journal
Journal of foot and ankle research
ISSN: 1757-1146
Titre abrégé: J Foot Ankle Res
Pays: England
ID NLM: 101471610
Informations de publication
Date de publication:
09 Apr 2021
09 Apr 2021
Historique:
received:
03
12
2020
accepted:
03
04
2021
entrez:
10
4
2021
pubmed:
11
4
2021
medline:
9
10
2021
Statut:
epublish
Résumé
The prevalence of diabetes is rising, and diabetes develops at a younger age in East Asia. Although lower limb amputation negatively affects quality of life and increases the risk of cardiovascular events, little is known about the rates and predictors of amputation among persons with diabetes from young adults to those in the "young-old" category (50-72 y). We analyzed data from a nationwide claims database in Japan accumulated from 2008 to 2016 involving 17,288 people with diabetes aged 18-72 y (mean age 50.2 y, HbA1c 7.2%). Amputation occurrence was determined according to information from the claims database. Cox regression model identified variables related to lower limb amputation. The mean follow-up time was 5.3 years, during which time 16 amputations occurred (0.17/1000 person-years). Multivariate Cox regression analysis showed that age (hazard ratio [HR] 1.09 [95% confidence intervals] 1.02-1.16, p = 0.01) and HbA1c (HR 1.46 [1.17-1.81], p < 0.01) were independently associated with amputations. Compared with those aged < 60 years with HbA1c < 8.0%, the HR for amputation was 27.81 (6.54-118.23) in those aged ≥60 years and HbA1c ≥8.0%. Age and HbA1c were associated with amputations among diabetic individuals, and the rates of amputation were significantly greater in those ≥60 years old and with HbA1c ≥8.0%.
Sections du résumé
BACKGROUND
BACKGROUND
The prevalence of diabetes is rising, and diabetes develops at a younger age in East Asia. Although lower limb amputation negatively affects quality of life and increases the risk of cardiovascular events, little is known about the rates and predictors of amputation among persons with diabetes from young adults to those in the "young-old" category (50-72 y).
METHODS
METHODS
We analyzed data from a nationwide claims database in Japan accumulated from 2008 to 2016 involving 17,288 people with diabetes aged 18-72 y (mean age 50.2 y, HbA1c 7.2%). Amputation occurrence was determined according to information from the claims database. Cox regression model identified variables related to lower limb amputation.
RESULTS
RESULTS
The mean follow-up time was 5.3 years, during which time 16 amputations occurred (0.17/1000 person-years). Multivariate Cox regression analysis showed that age (hazard ratio [HR] 1.09 [95% confidence intervals] 1.02-1.16, p = 0.01) and HbA1c (HR 1.46 [1.17-1.81], p < 0.01) were independently associated with amputations. Compared with those aged < 60 years with HbA1c < 8.0%, the HR for amputation was 27.81 (6.54-118.23) in those aged ≥60 years and HbA1c ≥8.0%.
CONCLUSIONS
CONCLUSIONS
Age and HbA1c were associated with amputations among diabetic individuals, and the rates of amputation were significantly greater in those ≥60 years old and with HbA1c ≥8.0%.
Identifiants
pubmed: 33836779
doi: 10.1186/s13047-021-00474-8
pii: 10.1186/s13047-021-00474-8
pmc: PMC8034178
doi:
Substances chimiques
Glycated Hemoglobin A
0
hemoglobin A1c protein, human
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
29Subventions
Organisme : Japan Society for the Promotion of Science
ID : 18K17897
Références
Bull World Health Organ. 2013 Sep 1;91(9):671-682D
pubmed: 24101783
Hypertension. 2001 Apr;37(4):1053-9
pubmed: 11304502
J Intern Med. 1993 Jun;233(6):485-91
pubmed: 8501419
J Foot Ankle Surg. 2020 Sep 3;:
pubmed: 33509714
Diabetes Res Clin Pract. 1997 Mar;35(2-3):149-56
pubmed: 9179471
PLoS One. 2020 Sep 16;15(9):e0239236
pubmed: 32936828
Diabetologia. 2012 Mar;55(3):552-65
pubmed: 22246373
Diabetologia. 2010 May;53(5):840-9
pubmed: 20127309
Circulation. 1997 Nov 4;96(9):3243-7
pubmed: 9386200
Diabetes Ther. 2017 Oct;8(5):1097-1109
pubmed: 28921256
Ann N Y Acad Sci. 2013 Apr;1281:64-91
pubmed: 23551121
Diabetes Care. 2020 Jan;43(Suppl 1):S111-S134
pubmed: 31862753
J Am Heart Assoc. 2019 Apr 16;8(8):e010627
pubmed: 30971163
Diabetes Metab Res Rev. 2019 Mar;35(3):e3120
pubmed: 30578707
J Vasc Surg. 2016 Feb;63(2 Suppl):22S-28S.e1-2
pubmed: 26804364
Diabetes Metab. 2017 Jun;43(3):261-264
pubmed: 27712966
J Clin Endocrinol Metab. 2011 Nov;96(11):3448-56
pubmed: 21865372
J Epidemiol. 2010;20(5):413-9
pubmed: 20699602
JAMA. 2013 Sep 4;310(9):916-7
pubmed: 24002277
Diabet Med. 1993 Apr;10(3):271-4
pubmed: 8485961
Diabetes Care. 2015 Jan;38(1):150-8
pubmed: 25538311
Intern Med. 2016;55(14):1827-30
pubmed: 27432088
Ann Intern Med. 2015 May 5;162(9):610-8
pubmed: 25938991
Lancet Diabetes Endocrinol. 2017 Dec;5(12):951-964
pubmed: 29079252
J Clin Endocrinol Metab. 2019 Nov 1;104(11):5084-5090
pubmed: 30994885
JAMA. 2009 May 27;301(20):2129-40
pubmed: 19470990
BMJ Open Diabetes Res Care. 2019 Oct 11;7(1):e000795
pubmed: 31749971
BMC Res Notes. 2018 Apr 27;11(1):260
pubmed: 29703224
N Engl J Med. 2014 Apr 17;370(16):1514-23
pubmed: 24738668
J Clin Endocrinol Metab. 2014 Dec;99(12):E2692-6
pubmed: 25202816
Diabetes Res Clin Pract. 2018 Mar;137:183-189
pubmed: 29382584
Circulation. 2012 Oct 30;126(18):2177-83
pubmed: 23109514
Diabetes Res Clin Pract. 2011 Jul;93(1):26-30
pubmed: 21466901
Diabetes Res Clin Pract. 2018 Jan;135:158-165
pubmed: 29133201
Diabetes Care. 2004 Aug;27(8):1885-91
pubmed: 15277412
Clin Sci (Lond). 2001 Dec;101(6):671-9
pubmed: 11724655
BMJ. 1998 Sep 12;317(7160):703-13
pubmed: 9732337