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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Metric Charcteristics of Sit-to-stand Tests in Patients After Lower-limb Amputation

Case Medical Research ◽

10.31525/ct1-nct04293237 ◽

2020 ◽

Author(s):

Keyword(s):

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Sit To Stand

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Prostheses and orthoses. Factors to be considered when specifying a prosthesis for a person who has had a lower limb amputation

10.3403/30178636 ◽

2009 ◽

Keyword(s):

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation

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Prostheses and orthoses. Factors to be included when describing physical activity of a person who has had a lower limb amputation(s) or who has a deficiency of a lower limb segment(s) present at birth

10.3403/30178633u ◽

2015 ◽

Keyword(s):

Physical Activity ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Limb Segment

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Prostheses and orthoses. Factors to be included when describing physical activity of a person who has had a lower limb amputation(s) or who has a deficiency of a lower limb segment(s) present at birth

10.3403/30178633 ◽

2009 ◽

Keyword(s):

Physical Activity ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Limb Segment

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P90 PERCEIVE: PrEdiction of Risk and Communication of outcome following major lower limb amputation - a collaboratIVE study

BJS Open ◽

10.1093/bjsopen/zrab032.089 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

B Gwilym ◽

C Waldron ◽

E Thomas-Jones ◽

P Pallmann ◽

R Preece ◽

...

Keyword(s):

Risk Prediction ◽

Lower Limb ◽

Health Care Professionals ◽

Healthcare Professionals ◽

Demographic Data ◽

Collaborative Study ◽

Lower Limb Amputation ◽

Research Network ◽

Limb Amputation ◽

Prediction Tools

Abstract Introduction Major Lower Limb Amputation (MLLA) is a life changing event with significant morbidity and mortality. Inaccurate risk prediction can lead to poor decision making, resulting in delay to definitive surgery, or undertaking amputation when not in the patient’s best interest. We aim to answer: In adult patients undergoing MLLA for chronic limb threatening ischaemia or diabetes, how accurately do health care professionals prospectively predict outcomes after MLLA, and how does this compare to existing prediction tools? Methods A multicentre prospective observational cohort study is being delivered through the Vascular and Endovascular Research Network. Dissemination was via an existing network of contacts and social media. Consecutive data will be collected for seven months from site launch date, including demographic data and pre-operative outcome predictions from surgeons, anaesthetists, and allied healthcare professionals. Follow-up data will comprise 30-day (mortality, morbidity, MLLA revision, surgical site infection, and blood transfusion) and 1-year (mortality, MLLA revision and ambulation). The accuracy of surgeons’ predictions will be evaluated and compared to pre-existing risk prediction scoring tools. Results PERCEIVE launched on 01/10/2020 with 23 centres (16 UK, 7 international) registered to collect data. 50 other centres (27 UK, 23 international) have expressed interest/are pursuing local audit/ethical approval. We aim to collect data on clinicians estimate of outcomes for over 500 patients. Discussion This study will utilise a trainee research network to provide data on the accuracy of healthcare professionals’ predictions of outcomes following MLLA and compare this to the utility of existing prediction tools in this patient cohort.

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