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. 2011 Jun;34(6):1350-4.
doi: 10.2337/dc10-2341. Epub 2011 May 3.

Time-dependent impact of diabetes on mortality in patients after major lower extremity amputation: survival in a population-based 5-year cohort in Germany

Andrea Icks  1 , Marsel Scheer, Stephan Morbach, Jutta Genz, Burkhard Haastert, Guido Giani, Gerd Glaeske, Falk Hoffmann
Affiliations

Time-dependent impact of diabetes on mortality in patients after major lower extremity amputation: survival in a population-based 5-year cohort in Germany

Andrea Icks et al. Diabetes Care. 2011 Jun.

Abstract

Objective: To estimate the impact of diabetes on mortality in patients after first major lower extremity amputation (LEA).

Research design and methods: Using claims data of a nationwide statutory health insurance, we assessed all deaths in a cohort of all 444 patients with a first major LEA since 2005 (71.8% male; mean age 69.1 years; 58.3% diabetic; 43% with amputation above the knee) up to 2009. Using Cox regression, we estimated the time-dependent hazard ratios to compare patients with and without diabetes.

Results: The cumulative 5-year mortality was 68% in diabetic and 59% in nondiabetic individuals. In the first course, mortality was lower in diabetic compared with nondiabetic patients. Later, the diabetes risk increased yielding crossed survival curves after 2 to 3 years (time dependency of diabetes; P = 0.003). Age- and sex-adjusted hazard ratios for diabetes were as follows: 0-30 days: 0.50 [95% CI 0.31-0.84]; 31-60 days: 0.60 [0.25-1.41]; 61 days to 6 months: 0.75 [0.38-1.48]; >6-12 months: 1.27 [0.63-2.53]; >12-24 months: 1.65 [0.88-3.08]; >24-36 months: 2.02 [0.80-5.09]; and >36-60 months: 1.91 [0.70-5.21]. The pattern was similar in both sexes. In the full model, significant risk factors for mortality were age (1.05; 1.03-1.06), amputation above the knee (1.50; 1.16-1.94), and quartile category 3 or 4 of the number of prescribed medications (1.64; 1.12-2.40 and 1.76; 1.20-2.59). Further adjustment for comorbidity did not alter the results.

Conclusions: In this population-based study, we found a time-dependent mortality risk of diabetes following first major LEA, which may be in part a result of a healthier lifestyle in diabetic patients or the access to specific treatment structures in diabetic individuals.

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Figures

Figure 1
Figure 1
Crude survival curves after first major LEA (GEK insurants, Germany, 2005–2009).
See this image and copyright information in PMC

References

    1. American Diabetes Association Standards of medical care in diabetes—2010 (Position Statement). Diabetes Care 2010;34(Suppl. 1):S11–S61 - PMC - PubMed
    1. World Health Organization. Diabetes Care and Research in Europe The Saint Vincent Declaration Geneva, World Health Org., 1989 (ICP/CLR 034)
    1. Icks A, Haastert B, Trautner C, Giani G, Glaeske G, Hoffmann F. Incidence of lower-limb amputations in the diabetic compared to the non-diabetic population. Findings from nationwide insurance data, Germany, 2005-2007. Exp Clin Endocrinol Diabetes 2009;117:500–504 - PubMed
    1. Eskelinen E, Eskelinen A, Albäck A, Lepäntalo M. Major amputation incidence decreases both in non-diabetic and in diabetic patients in Helsinki. Scand J Surg 2006;95:185–189 - PubMed
    1. Heikkinen M, Saarinen J, Suominen VP, Virkkunen J, Salenius J. Lower limb amputations: differences between the genders and long-term survival. Prosthet Orthot Int 2007;31:277–286 - PubMed

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