Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Apr 14;7(1):e000602.
doi: 10.1136/bmjdrc-2018-000602. eCollection 2019.

Excess risk of lower extremity amputations in people with type 1 diabetes compared with the general population: amputations and type 1 diabetes

Arndís Finna Ólafsdóttir  1   2 , Ann-Marie Svensson  2   3 , Aldina Pivodic  4 , Soffia Gudbjörnsdottir  2   3 , Thomas Nyström  5 , Hans Wedel  6 , Annika Rosengren  2 , Marcus Lind  1   2
Affiliations

Excess risk of lower extremity amputations in people with type 1 diabetes compared with the general population: amputations and type 1 diabetes

Arndís Finna Ólafsdóttir et al. BMJ Open Diabetes Res Care. .

Abstract

Objective: This study investigates how the excess risk of lower extremity amputations (amputations) in people with type 1 diabetes mellitus (DM) differs from the general population by diabetes duration, glycemic control, and renal complications.

Research design and methods: We analyzed data from people with type 1 DM from the Swedish National Diabetes Register without prior amputation from January 1998 to December 2013. Each person (n=36 872) was randomly matched with five controls by sex, age, and county (n=184 360) from the population without diabetes. All were followed until first amputation, death or end of follow-up.

Results: The overall adjusted HR for all amputation was 40.1 (95% CI 32.8 to 49.1) for type 1 DM versus controls. HR increased with longer diabetes duration. The incidence of amputation/1000 patient-years was 3.18 (95% CI 2.99 to 3.38) for type 1 DM and 0.07 (95% CI 0.05 to 0.08) for controls. The incidence decreased from 1998-2001 (3.09, 95% CI 2.56 to 3.62) to 2011-2013 (2.64, 95% CI 2.31 to 2.98). The HR for major amputations was lower than for minor amputations and decreased over the time period (p=0.0045). Worsening in glycemic control among patients with diabetes led to increased risk for amputation with an HR of 1.80 (95% CI 1.72 to 1.88) per 10 mmol/mol (1%) increase in hemoglobin A1c.

Conclusions: Although the absolute risk of amputation is relatively low, the overall excess risk was 40 times that of controls. Excess risk was substantially lower for those with good glycemic control and without renal complications, but excess risk still existed and is greatest for minor amputations.

Keywords: HbA1c; lower extremity amputations; minor amputations; renal failure; type 1 diabetes.

PubMed Disclaimer

Conflict of interest statement

Competing interests: ML has received grants from AstraZeneca, Dexcom, Novo Nordisk and Pfizer; and consulting fees from AstraZeneca, Eli Lilly, Dexcom, MSD, Novo Nordisk, and Rubin Medical. TN has received unrestricted grants from AstraZeneca and consulting fees from Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Merck and Sanofi-Aventis. AFÓ, A-MS, SG, AR and AP declared no competing interests.

Figures

Figure 1
Figure 1
Crude age-adjusted and sex-adjusted incidence rates of amputations over time. (A) Overall, (B) minor amputations and (C) major amputations. The exact estimates with 95% CI are reported in online supplementary table 3.
See this image and copyright information in PMC

References

    1. Berne C, Agardh C-D. 2009 diabetes. 4 ed Stockholm: Liber.
    1. Mohammedi K, Potier L, Belhatem N, et al. . Lower-extremity amputation as a marker for renal and cardiovascular events and mortality in patients with long standing type 1 diabetes. Cardiovasc Diabetol 2016;15 10.1186/s12933-015-0322-0 - DOI - PMC - PubMed
    1. Gerdtham UG, Clarke P, Hayes A, et al. . Estimating the cost of diabetes mellitus-related events from inpatient admissions in Sweden using administrative hospitalization data. Pharmacoeconomics 2009;27:81–90. 10.2165/00019053-200927010-00008 - DOI - PubMed
    1. Jonasson JM, Ye W, Sparén P, et al. . Risks of nontraumatic lower-extremity amputations in patients with type 1 diabetes: a population-based cohort study in Sweden. Diabetes Care 2008;31:1536–40. 10.2337/dc08-0344 - DOI - PMC - PubMed
    1. Jørgensen ME, Almdal TP, Faerch K. Reduced incidence of lower-extremity amputations in a Danish diabetes population from 2000 to 2011. Diabet Med 2014;31:443–7. 10.1111/dme.12320 - DOI - PubMed

Publication types