Rates and risk factors for amputation in people with diabetes in Japan: a historical cohort study using a nationwide claims database

Abstract Background: Because amputation negatively affects the quality of life of patients with diabetes and increases the risk of cardiovascular events and mortality, predictors of amputation must be identified. However, no large cohort studies have been conducted regarding the incidence of amputation in patients with diabetes in East Asia.Methods: We analyzed data from a nationwide claims database in Japan accumulated from 2008–2016, involving 17,288 patients with diabetes aged 18–72 y (2942 women, mean age 50.2 y, HbA1c 7.2%).Results: The mean follow-up time was 5.3 years, and 16 amputations occurred (0.17/1000 person-years). Multivariate Cox regression analysis showed that age and HbA1c levels were independent predictors of amputation (hazard ratios [HRs], 1.09 and 1.43; 95% confidence intervals [CIs], 1.01–1.16 and 1.12–1.82, respectively). Compared with patients aged <60 y and with HbA1c <8%, the HR for patients aged ≥60 y and with HbA1c ≥8% was 32.1 (95% CI, 7.30–141.2).Conclusions: Improved glycemic control may lower amputation risk.

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Obstructive sleep apnoea is not a risk factor for incident hospitalised depression: a historical cohort study

European Respiratory Journal ◽

10.1183/13993003.01361-2016 ◽

2017 ◽

Vol 49 (6) ◽

pp. 1601361 ◽

Cited By ~ 8

Author(s):

Tetyana Kendzerska ◽

Andrea S. Gershon ◽

Gillian A. Hawker ◽

George A. Tomlinson ◽

Richard S. Leung

Keyword(s):

Obstructive Sleep Apnoea ◽

Cox Regression ◽

Sleep Apnoea ◽

Sleep Study ◽

Historical Cohort ◽

Cox Regression Analysis ◽

Younger Age ◽

Obstructive Sleep ◽

Potential Link

We evaluated whether obstructive sleep apnoea (OSA) was related to the incidence of hospitalisation for depression, a robust end-point that is unlikely to result from misdiagnosis.All adults referred with suspected OSA who underwent a diagnostic sleep study at a large urban academic hospital between 1994 and 2010 and were linked to provincial health administrative data between 1991 and 2015 were included. Cox regression analysis was used to investigate the association between OSA symptoms and severity and incident hospitalised depression, the primary outcome.Over a median follow-up of 9.7 years, 136 (1.3%) out of 10 149 participants were hospitalised for depression. A significant crude effect of OSA symptoms (waking unrefreshed and impact on memory and concentration) on hospitalised depression became nonsignificant after controlling for confounders. Apnoea–hypopnoea index was not significantly associated with the outcome: adjusted hazard ratio (33 versus6 events·h−1) 1.13 (95% CI 0.91–1.40). Factors associated with hospitalised depression were female sex, younger age, use of hypnotics, alcoholism and unemployment.In a large clinical cohort with suspected OSA, controlling for confounders, OSA symptoms and severity were not related to the risk of hospitalisation for depression, suggesting that previously reported links between OSA and depression may be due to overlapping diagnostic criteria. However, our findings cannot exclude a potential link between OSA and milder depression.

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Quality of Life of Persons With Lower-Limb Amputation During Rehabilitation and at 3-Month Follow-Up

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2008.11.003 ◽

2009 ◽

Vol 90 (4) ◽

pp. 634-645 ◽

Cited By ~ 62

Author(s):

Diana Zidarov ◽

Bonnie Swaine ◽

Christiane Gauthier-Gagnon

Keyword(s):

Quality Of Life ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation

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Association Between the ACE Insertion/Deletion Polymorphism and Risk of Lower-Limb Amputation in Patients With Long-Standing Type 1 Diabetes

10.2337/figshare.16924237 ◽

2021 ◽

Author(s):

Kamel Mohammedi ◽

Yawa Abouleka ◽

Charlyne Carpentier ◽

Louis Potier ◽

Severine Dubois ◽

...

Keyword(s):

Type 1 Diabetes ◽

Lower Limb ◽

Cox Regression ◽

Lower Limb Amputation ◽

Limb Amputation ◽

History Of ◽

Independent Association ◽

Design And Methods

OBJECTIVE. The ACE insertion/deletion (I/D) polymorphism has been widely studied in people with diabetes, albeit not regarding lower-limb amputation (LLA). We examined associations between this polymorphism, plasma ACE concentration and LLA in people with type 1 diabetes. RESEARCH DESIGN AND METHODS. ACE I/D genotype and plasma ACE were assessed in three prospective cohorts of participants with type 1 diabetes. LLA was defined as minor (below the ankle amputation consisting of at least 1-ray metatarsal resection) or major (transtibial or transfemoral) amputation. Linear, logistic and Cox regression models were computed to evaluate the likelihood of prevalent and incident LLA by ACE genotype (XD [ID or ID] versus II) and plasma ACE, after adjusting for confounders. RESULTS. Among 1301 participants (male 54%, age 41±13 years), 90 (6.9%) participants had a baseline history of LLA. Baseline LLA was more prevalent in XD (7.4%) than in II genotype (4.5%): OR 2.17 (95%CI, 1.03–4.60). Incident LLA occurred in 53 individuals during 14-year follow-up. It was higher in XD versus II carriers: HR 3.26 (1.16–13.67). This association was driven by excess risk of minor, but not major, LLA. The D-allele was associated with increased prevalent LLA at the end of follow-up (OR 2.48 [1.33–4.65]). LLA was associated with higher ACE levels in II (449 [360–539] versus 354 [286–423] ng/ml), but not in XD carriers (512 [454–570] versus 537 [488–586]). CONCLUSIONS. This is the first report of an independent association between ACE D-allele and excess LLA risk, mainly minor amputations, in patients with type 1 diabetes.

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Association Between the ACE Insertion/Deletion Polymorphism and Risk of Lower-Limb Amputation in Patients With Long-Standing Type 1 Diabetes

10.2337/figshare.16924237.v1 ◽

2021 ◽

Author(s):

Kamel Mohammedi ◽

Yawa Abouleka ◽

Charlyne Carpentier ◽

Louis Potier ◽

Severine Dubois ◽

...

Keyword(s):

Type 1 Diabetes ◽

Lower Limb ◽

Cox Regression ◽

Lower Limb Amputation ◽

Limb Amputation ◽

History Of ◽

Independent Association ◽

Design And Methods

OBJECTIVE. The ACE insertion/deletion (I/D) polymorphism has been widely studied in people with diabetes, albeit not regarding lower-limb amputation (LLA). We examined associations between this polymorphism, plasma ACE concentration and LLA in people with type 1 diabetes. RESEARCH DESIGN AND METHODS. ACE I/D genotype and plasma ACE were assessed in three prospective cohorts of participants with type 1 diabetes. LLA was defined as minor (below the ankle amputation consisting of at least 1-ray metatarsal resection) or major (transtibial or transfemoral) amputation. Linear, logistic and Cox regression models were computed to evaluate the likelihood of prevalent and incident LLA by ACE genotype (XD [ID or ID] versus II) and plasma ACE, after adjusting for confounders. RESULTS. Among 1301 participants (male 54%, age 41±13 years), 90 (6.9%) participants had a baseline history of LLA. Baseline LLA was more prevalent in XD (7.4%) than in II genotype (4.5%): OR 2.17 (95%CI, 1.03–4.60). Incident LLA occurred in 53 individuals during 14-year follow-up. It was higher in XD versus II carriers: HR 3.26 (1.16–13.67). This association was driven by excess risk of minor, but not major, LLA. The D-allele was associated with increased prevalent LLA at the end of follow-up (OR 2.48 [1.33–4.65]). LLA was associated with higher ACE levels in II (449 [360–539] versus 354 [286–423] ng/ml), but not in XD carriers (512 [454–570] versus 537 [488–586]). CONCLUSIONS. This is the first report of an independent association between ACE D-allele and excess LLA risk, mainly minor amputations, in patients with type 1 diabetes.

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Impact of the COVID-19 restrictions on physical activity and quality of life in adults with lower limb amputation

Prosthetics and Orthotics International ◽

10.1097/pxr.0000000000000078 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Mirjam Mellema ◽

Martha Risnes ◽

Peyman Mirtaheri ◽

Terje Gjøvaag

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation

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Prosthesis satisfaction and quality of life in US service members with combat-related major lower-limb amputation

Prosthetics and Orthotics International ◽

10.1097/pxr.0000000000000054 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Susan L. Eskridge ◽

Amber L. Dougherty ◽

Jessica R. Watrous ◽

Cameron T. McCabe ◽

Jill M. Cancio ◽

...

Keyword(s):

Quality Of Life ◽

Lower Limb ◽

Lower Limb Amputation ◽

Service Members ◽

Limb Amputation

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Perineural local anaesthetic catheter after major lower limb amputation trial (PLACEMENT): results from a randomised controlled feasibility trial

BMJ Open ◽

10.1136/bmjopen-2019-029233 ◽

2019 ◽

Vol 9 (11) ◽

pp. e029233 ◽

Cited By ~ 3

Author(s):

David Bosanquet ◽

Graeme Ambler ◽

Cherry-Ann Waldron ◽

Emma Thomas-Jones ◽

Lucy Brookes-Howell ◽

...

Keyword(s):

Postoperative Pain ◽

Local Anaesthetic ◽

Lower Limb ◽

Rating Scale ◽

Lower Limb Amputation ◽

Feasibility Trial ◽

Limb Amputation ◽

Effectiveness Trial ◽

Randomised Controlled

ObjectivesTo determine the feasibility of undertaking a randomised controlled effectiveness trial evaluating the use of a perineural catheter (PNC) after major lower limb amputation with postoperative pain as the primary outcome.DesignRandomised controlled feasibility trial.SettingTwo vascular Centres in South Wales, UK.Participants50 patients scheduled for major lower limb amputation (below or above knee) for complications of peripheral vascular disease.InterventionsThe treatment arm received a PNC placed adjacent to the sciatic or tibial nerve at the time of surgery, with continuous infusion of levobupivacaine hydrochloride 0.125% for up to 5 days. The control arm received neither local anaesthetic nor PNC. Both arms received usual perioperative anaesthesia and postoperative analgesia.Primary and secondary outcome measuresThe primary outcomes were the proportion of eligible patients who were randomised and the proportion of recruited patients who provided primary effectiveness outcome data. Secondary outcomes were: the proportion of recruited patients reaching 2 and 6 month follow-up and supplying pain data; identification of key cost drivers; development of an economic analysis framework for a future effectiveness trial; identification of barriers to recruitment and site set-up; and identification of the best way to measure postoperative pain.ResultsSeventy-six of 103 screened patients were deemed eligible over a 10 month period. Fifty (64.5%) of these patients were randomised, with one excluded in the perioperative period. Forty-five (91.3%) of 49 recruited patients provided enough pain scores on a 4-point verbal rating scale to allow primary effectiveness outcome evaluation. Attrition rates were high; 18 patients supplied data at 6 month follow-up. Costs were dominated by length of hospital stay. Patients and healthcare professionals reported that trial processes were acceptable.ConclusionsRecruitment of patients into a trial comparing PNC use to usual care after major lower limb amputation with postoperative pain measured on a 4-point verbal rating scale is feasible. Evaluation of longer-term symptoms is difficult.Trial registration numberISRCTN: 85 710 690. EudraCT: 2016-003544-37.

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