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Amputations and foot ulcers in patients newly diagnosed with Type 2 diabetes mellitus and observed for 19 years. The role of age, gender and co‐morbidity
Author(s) -
Bruun C.,
Siersma V.,
Guassora A. D.,
Holstein P.,
Fine Olivarius N.
Publication year - 2013
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12196
Subject(s) - medicine , hazard ratio , odds ratio , diabetes mellitus , amputation , incidence (geometry) , retinopathy , diabetic foot , proportional hazards model , myocardial infarction , type 2 diabetes , surgery , confidence interval , endocrinology , physics , optics
Aims To determine the prevalence of foot ulcers and the incidence of amputations in patients with Type 2 diabetes observed for 19 years after diagnosis. We investigated the role of gender, age and co‐morbidities. Methods From the Diabetes Care in General Practice study, 1381 patients were included and examined at diabetes diagnosis, at 6 years and at 14 years after diagnosis. Register‐based follow‐up was for 19 years. Foot ulcers and amputations were related to gender, age and co‐morbidities by odds and hazard ratios from logistic and Cox regression models, respectively. Results The incidence of any amputation and major amputation was 400 (95% CI 307–512) and 279 (95% CI 203–375) per 100 000 patient‐years, respectively. At the three observation points, the foot ulcer prevalences were 2.76% (95% CI 1.89–3.63), 2.93% (95% CI 1.86–4.00) and 4.96% (95% CI 3.10–6.82). Multivariate analyses showed associations between foot ulcers and peripheral neuropathy, peripheral arterial disease, male gender, retinopathy and myocardial infarction. After multivariate adjustment, significant predictors (hazard ratio; 95% CI ) of any amputation were peripheral neuropathy (hazard ratio 2.09; 95% CI 1.19–3.69), peripheral arterial disease (hazard ratio 3.43; 95% CI 1.65–7.12), microalbuminuria (hazard ratio 2.11; 95% CI 1.21–3.67), retinopathy (hazard ratio 6.42; 95% CI 2.59–15.90), impaired vision (hazard ratio 6.92; 95% CI 2.35–20.38) and male gender (hazard ratio 2.40; 95% CI 1.31–4.41). For women, the risk of amputation increased with age, but for men the risk was higher when diagnosed with diabetes at a younger age. Conclusions Despite improved treatment regimens, the incidence of amputations is still high in this population‐based patient sample. Men diagnosed with diabetes before age 65 years and patients with diabetes‐related co‐morbidities are at particularly high risk of foot ulcers and amputations.