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

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

<b>OBJECTIVE. </b>The <i>ACE</i> 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. <b></b> <p><b>RESEARCH DESIGN AND METHODS. </b><i>ACE </i>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 <i>ACE</i> genotype (XD [ID or ID] versus II) and plasma ACE, after adjusting for confounders.<b></b></p> <p><b>RESULTS. </b>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 <i>versus</i> 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]).</p> <p><b>CONCLUSIONS</b>. This is the first report of an independent association between <i>ACE</i> D-allele and excess LLA risk, mainly minor amputations, in patients with type 1 diabetes.</p>

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

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

<b>OBJECTIVE. </b>The <i>ACE</i> 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. <b></b> <p><b>RESEARCH DESIGN AND METHODS. </b><i>ACE </i>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 <i>ACE</i> genotype (XD [ID or ID] versus II) and plasma ACE, after adjusting for confounders.<b></b></p> <p><b>RESULTS. </b>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 <i>versus</i> 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]).</p> <p><b>CONCLUSIONS</b>. This is the first report of an independent association between <i>ACE</i> D-allele and excess LLA risk, mainly minor amputations, in patients with type 1 diabetes.</p>

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

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Masanori Kaneko ◽  
Kazuya Fujihara ◽  
Mayuko Yamada Harada ◽  
Taeko Osawa ◽  
Masahiko Yamamoto ◽  
...  
Keyword(s):  
Lower Limb ◽  
Cox Regression ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Historical Cohort ◽  
Cox Regression Analysis ◽  
Claims Database ◽  
Younger Age

Abstract Background The prevalence of diabetes is rising, and diabetes develops at a younger age in East Asia. Although lower limb amputation negatively affects quality of life and increases the risk of cardiovascular events, little is known about the rates and predictors of amputation among persons with diabetes from young adults to those in the “young-old” category (50–72 y). Methods We analyzed data from a nationwide claims database in Japan accumulated from 2008 to 2016 involving 17,288 people with diabetes aged 18–72 y (mean age 50.2 y, HbA1c 7.2%). Amputation occurrence was determined according to information from the claims database. Cox regression model identified variables related to lower limb amputation. Results The mean follow-up time was 5.3 years, during which time 16 amputations occurred (0.17/1000 person-years). Multivariate Cox regression analysis showed that age (hazard ratio [HR] 1.09 [95% confidence intervals] 1.02–1.16, p = 0.01) and HbA1c (HR 1.46 [1.17–1.81], p < 0.01) were independently associated with amputations. Compared with those aged < 60 years with HbA1c < 8.0%, the HR for amputation was 27.81 (6.54–118.23) in those aged ≥60 years and HbA1c ≥8.0%. Conclusions Age and HbA1c were associated with amputations among diabetic individuals, and the rates of amputation were significantly greater in those ≥60 years old and with HbA1c ≥8.0%.

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

Diabetes Care ◽  
2021 ◽  
pp. dc210973
Author(s):  
Kamel Mohammedi ◽  
Yawa Abouleka ◽  
Charlyne Carpentier ◽  
Louis Potier ◽  
Severine Dubois ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Deletion Polymorphism

Independent Association of a Metabolic Syndrome Severity Score with All-Cause Mortality in Type 1 Diabetes—A 10-Year Follow-Up

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 618-P
Author(s):  
GIUSEPPE PENNO ◽  
MONIA GAROFOLO ◽  
ROSA GIANNARELLI ◽  
FABRIZIO CAMPI ◽  
DANIELA LUCCHESI ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Type 1 Diabetes ◽  
Severity Score ◽  
All Cause Mortality ◽  
Independent Association

A Decade of Disparities in Diabetes Technology Use and HbA1c in Pediatric Type 1 Diabetes: A Trans-Atlantic Comparison

2020 ◽  
Author(s):  
Ananta Addala ◽  
Marie Auzanneau ◽  
Kellee Miller ◽  
Werner Maier ◽  
Nicole Foster ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Technology Use ◽  
Hemoglobin A1c ◽  
Diabetes Technology ◽  
Design And Methods ◽  
Relationship Of ◽  
The Relationship ◽  
Pediatric Type 1 Diabetes

<b>Objective:</b> As diabetes technology use in youth increases worldwide, inequalities in access may exacerbate disparities in hemoglobin A1c (HbA1c). We hypothesized an increasing gap in diabetes technology use by socioeconomic status (SES) would be associated with increased HbA1c disparities. <p> </p> <p><b>Research Design and Methods: </b>Participants aged <18 years with diabetes duration ≥1 year in the Type 1 Diabetes Exchange (T1DX, US, n=16,457) and Diabetes Prospective Follow-up (DPV, Germany, n=39,836) registries were categorized into lowest (Q1) to highest (Q5) SES quintiles. Multiple regression analyses compared the relationship of SES quintiles with diabetes technology use and HbA1c from 2010-2012 and 2016-2018. </p> <p> </p> <p><b>Results: </b>HbA1c was higher in participants with lower SES (in 2010-2012 & 2016-2018, respectively: 8.0% & 7.8% in Q1 and 7.6% & 7.5% in Q5 for DPV; and 9.0% & 9.3% in Q1 and 7.8% & 8.0% in Q5 for T1DX). For DPV, the association between SES and HbA1c did not change between the two time periods, whereas for T1DX, disparities in HbA1c by SES increased significantly (p<0.001). After adjusting for technology use, results for DPV did not change whereas the increase in T1DX was no longer significant.</p> <p> </p> <p><b>Conclusions: </b>Although causal conclusions cannot be drawn, diabetes technology use is lowest and HbA1c is highest in those of the lowest SES quintile in the T1DX and this difference for HbA1c broadened in the last decade. Associations of SES with technology use and HbA1c were weaker in the DPV registry. </p>

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

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e029233 ◽  
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.

scholarly journals Risk of early mortality and cardiovascular disease in type 1 diabetes: a comparison with type 2 diabetes, a nationwide study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
You-Bin Lee ◽  
Kyungdo Han ◽  
Bongsung Kim ◽  
Seung-Eun Lee ◽  
Ji Eun Jun ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Cox Regression ◽  
Early Mortality ◽  
Hazard Ratios ◽  
Epidemiological Characteristics

Abstract Background Both type 1 and type 2 diabetes are well-established risk factors for cardiovascular disease and early mortality. However, few studies have directly compared the hazards of cardiovascular outcomes and premature death among people with type 1 diabetes to those among people with type 2 diabetes and subjects without diabetes. Furthermore, information about the hazard of cardiovascular disease and early mortality among Asians with type 1 diabetes is sparse, although the clinical and epidemiological characteristics of Asians with type 1 diabetes are unlike those of Europeans. We estimated the hazard of myocardial infarction (MI), hospitalization for heart failure (HF), atrial fibrillation (AF), and mortality during follow-up in Korean adults with type 1 diabetes compared with those without diabetes and those with type 2 diabetes. Methods We used Korean National Health Insurance Service datasets of preventive health check-ups from 2009 to 2016 in this retrospective longitudinal study. The hazard ratios of MI, HF, AF, and mortality during follow-up were analyzed using the Cox regression analyses according to the presence and type of diabetes in ≥ 20-year-old individuals without baseline cardiovascular disease (N = 20,423,051). The presence and type of diabetes was determined based on the presence of type 1 or type 2 diabetes at baseline. Results During more than 93,300,000 person-years of follow-up, there were 116,649 MIs, 135,532 AF cases, 125,997 hospitalizations for HF, and 344,516 deaths. The fully-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident MI, hospitalized HF, AF, and all-cause death within the mean follow-up of 4.6 years were higher in the type 1 diabetes group than the type 2 diabetes [HR (95% CI) 1.679 (1.490–1.893) for MI; 2.105 (1.901–2.330) for HF; 1.608 (1.411–1.833) for AF; 1.884 (1.762–2.013) for death] and non-diabetes groups [HR (95% CI) 2.411 (2.138–2.718) for MI; 3.024 (2.730–3.350) for HF; 1.748 (1.534–1.993) for AF; 2.874 (2.689–3.073) for death]. Conclusions In Korea, the presence of diabetes was associated with a higher hazard of cardiovascular disease and all-cause death. Specifically, people with type 1 diabetes had a higher hazard of cardiovascular disease and all-cause mortality compared to people with type 2 diabetes.

Lower limb amputation Part 3: Prosthetics - a 10 year literature review

2001 ◽  
Vol 25 (1) ◽  
pp. 21-28 ◽  
Author(s):  
H. Cochrane ◽  
K. Orsi ◽  
P. Reilly
Keyword(s):  
Literature Review ◽  
Lower Limb ◽  
Consensus Conference ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Amputation Surgery

This paper is intended as a follow-up to the ISPO Consensus Conference on Amputation Surgery. It reviews all the literature on lower limb prosthetics published after 1990. The review was considered under six categories: feet, knees, hips, thermoplastics, liners/suspension and computers.

scholarly journals Frequent physical activity is associated with reduced risk of severe diabetic retinopathy in type 1 diabetes

2019 ◽  
Vol 57 (5) ◽  
pp. 527-534 ◽  
Author(s):  
Heidi Tikkanen-Dolenc ◽  
◽  
Johan Wadén ◽  
Carol Forsblom ◽  
Valma Harjutsalo ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Laser Treatment ◽  
Lower Incidence ◽  
Cox Regression ◽  
Age At Onset ◽  
Self Report

Abstract Aims The aim of this study was to investigate whether leisure-time physical activity (LTPA) is associated with the development of severe diabetic retinopathy in individuals with type 1 diabetes. Methods Prospective observational analysis as part of the Finnish diabetic nephropathy (FinnDiane) Study with a mean follow-up time of 10.7 years was performed. A total of 1612 individuals with type 1 diabetes were recruited, and LTPA was assessed at baseline using a validated self-report questionnaire. Severe diabetic retinopathy was defined as the initiation of laser treatment due to severe nonproliferative, proliferative retinopathy or diabetic maculopathy (identified from the Care Register for Health Care). Results A total of 261 patients received laser treatment during the follow-up. Higher frequency of LTPA was associated with a lower incidence of severe diabetic retinopathy (p = 0.024), a finding that remained significant after adjustment for gender, duration, age at onset of diabetes, kidney function, BMI, triglycerides and systolic blood pressure. However, when HbA1c and smoking were added to the Cox regression model the association was no more significant. Conclusions Frequent LTPA is associated with a lower incidence of severe diabetic retinopathy during the follow-up. The total amount or the other components of LTPA (intensity or duration of a single session) were not associated with severe diabetic retinopathy.

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