Smoking, little physical activity increase risk for lower limb amputations in diabetes
Click Here to Manage Email Alerts
Key takeaways:
- The risk for lower limb amputations for people with diabetes increases with age and for those who smoke or exercise less.
- Adults with obesity may have a lower risk for amputations than those with normal weight.
Adults with diabetes who smoke or exercise less than once per week are among those at higher risk for a lower limb amputation, but adults with obesity may have a lower risk for amputations, according to study data.
In findings from an observational cohort study that will be presented at the European Association for the Study of Diabetes annual meeting, researchers analyzed risk factors for lower limb amputation among adults with diabetes. In addition to lifestyle variables being associated with lower limb amputation risk, the risk for amputations was higher for older adults, men and those who were divorced.
“Lifestyle variables have a strong association with lower limb amputation,” Stefan Jansson, PhD, MD, GP, affiliated researcher in the university health care research center, faculty of medicine and health at Örebro University in Sweden, told Healio. “Providers should prioritize that people should be nonsmokers and be physically active.”
Jansson and colleagues collected data from the Swedish national diabetes register of 66,569 adults aged 18 years and older who were diagnosed with incident diabetes and had no previous amputation from 2007 to 2016. Incident lower limb amputations and risk factors were obtained from several Swedish registries. Follow-up continued until amputation, emigration from Sweden, death or the end of the study in 2017.
During a median follow-up of 4 years, there were 133 lower limb amputations. After adjusting for covariates, adults who were divorced had a higher risk for lower limb amputations than those who were married (aHR = 1.67; 95% CI, 1.07-2.6) and men had a higher risk for amputations than women (aHR = 1.57; 95% CI, 1.06-2.34). The risk for lower limb amputations increased by 8% for each year of older age (adjusted HR = 1.08; 95% CI, 1.05-1.1).
“Older persons with newly diagnosed diabetes should receive extra attention even if the disease duration is relatively short, as older age is associated with a higher risk for lower limb amputations,” Jansson said.
Adults with neuropathy or angiopathy (aHR = 4.12; 95% CI, 2.84-5.98), previous foot wounds (aHR = 8.26; 95% CI, 3.29-20.74) and ongoing severe foot disease (aHR = 11.24; 95% CI, 4.82-26.23) had a higher risk for lower limb amputations than adults with healthy feet.
Adults receiving insulin had a higher risk for lower limb amputations than those receiving diet-only diabetes treatment (aHR = 2.03; 95% CI, 1.1-3.74). Those with obesity had a lower risk for amputations than adults with normal weight (aHR = 0.46; 95% CI, 0.29-0.75) a finding that Jansson said was very surprising.
“As this is an observational study, we cannot be sure about why it is so,” Jansson said. “It could be down to chance, or some people of normal weight may have lost weight due to illness, putting them at a higher relative risk [for] lower limb amputations.”
Adults who smoked had a higher risk for lower limb amputations than those who did not smoke (aHR = 1.99; 95% CI, 1.28-3.09). Exercising less than one time per week increased the risk for amputations compared with exercising once per day (aHR = 2.05; 95% CI, 1.3-3.23).
Jansson said future research should be focused on interventions that can reduce the risk for lower limb amputations for people with diabetes.
Collapse
Jansson SPO, et al. Abstract 216. Presented at: European Association for the Study of Diabetes Annual Meeting; Oct. 2-6, 2023; Hamburg, Germany.
Read more about
Click Here to Manage Email Alerts