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Lower extremity amputations increase with poor glycemic control in type 1 diabetes

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SAN DIEGO — The risk for lower extremity amputations in adults with type 1 diabetes increases with poor glycemic control, severe renal complications and longer diabetes duration, according to a speaker here.

Arndis F. Olafsdottir, RN, BSc, of the department of molecular and clinical medicine at the University of Gothenburg, Sweden, and colleagues evaluated data on 33,616 people with type 1 diabetes without prior lower extremity amputations between January 1998 and December 2011. Five controls without diabetes were matched by sex, age and county to each participant (n = 167,721).

“The aim of this study was to analyze the overall excess risk of [lower extremity amputations] in patients with type 1 diabetes compared to the general population and how this is affected by glycemic control, renal complications and diabetes,” Olafsdottir said during her presentation.

Participants were followed until first lower extremity amputation, death or end of follow-up.

Mean age of participants was 35.6 years; 45.3% were women, mean HbA1c was 8.2%, mean diabetes duration was 20.2 years and 3.7% had prior foot ulcers.

The incidence of lower extremity amputation was higher among participants with diabetes (3.11 per 1,000 person years) compared with controls (0.12 per 1,000 person years; adjusted HR = 21.1; 95% CI, 217.7-25.2).

There were no lower extremity amputation events in participants with HbA1c less than 7.8%, those without renal complications or those with less than 20 years’ diabetes duration. Longer diabetes duration, poor glycemic control and high severity of renal complications increased the risk for lower extremity amputations.

“We can speculate that the risk for lower extremity amputations can be improved as glycemic control improves,” Olafsdottir said.

Reference:

Olafsdottir AF, et al. 103-OR. Presented at: American Diabetes Association 77th Scientific Sessions; June 9-13, 2017; San Diego.

Disclosures: Olafsdottir reports no relevant financial disclosures.