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. 2022 Oct;37(5):770-780.
doi: 10.3803/EnM.2022.1519. Epub 2022 Oct 12.

Association among Current Smoking, Alcohol Consumption, Regular Exercise, and Lower Extremity Amputation in Patients with Diabetic Foot: Nationwide Population-Based Study

Yoon Jae Lee  1 , Kyung-Do Han  2 , Jun Hyeok Kim  1
Affiliations

Association among Current Smoking, Alcohol Consumption, Regular Exercise, and Lower Extremity Amputation in Patients with Diabetic Foot: Nationwide Population-Based Study

Yoon Jae Lee et al. Endocrinol Metab (Seoul). 2022 Oct.

Abstract

Backgruound: The present study investigates whether modifiable behavioral factors of current cigarette smoking, heavy alcohol consumption, and regular exercise are associated with risk of lower extremity amputation (LEA) in diabetic patients.

Methods: A total of 2,644,440 diabetic patients (aged ≥20 years) was analyzed using the database of the Korean National Health Insurance Service. Cox proportional hazard regression was used to assess adjusted hazard ratios (HRs) for the behavioral factors with risk of LEA under adjustment for potential confounders.

Results: The risk of LEA was significantly increased by current cigarette smoking and heavy alcohol consumption (HR, 1.436; 95% confidence interval [CI], 1.367 to 1.508 and HR, 1.082; 95% CI, 1.011 to 1.158) but significantly decreased with regular exercise (HR, 0.745; 95% CI, 0.706 to 0.786) after adjusting for age, sex, smoking, alcohol consumption, exercise, low income, hypertension, dyslipidemia, body mass index, using insulin or oral antidiabetic drugs, and diabetic duration. A synergistically increased risk of LEA was observed with larger number of risky behaviors.

Conclusion: Modification of behaviors of current smoking, heavy alcohol intake, and exercise prevents LEA and can improve physical, emotional, and social quality of life in diabetic patients.

Keywords: Alcohol drinking; Amputation risk assessment; Diabetic foot; Exercise habits; Smoking.

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Conflict of interest statement

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Flowchart showing the enrollment process for the study cohort. NHIS, National Health Insurance Service.
Fig. 2.
Fig. 2.
Kaplan-Meier curves for cumulative incidence of lower extremity amputation in a diabetic population at biennial intervals. (A) Depending on current cigarette smoking. (B) Depending on heavy alcohol consumption. (C) Depending on regular exercise.
None
See this image and copyright information in PMC

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