Time Trends in the Incidence of Long-Term Mortality in T2DM Patients Who Have Undergone a Lower Extremity Amputation. Results of a Descriptive and Retrospective Cohort Study

López‐de‐Andrés, Ana; Jiménez-García, Rodrigo; Esteban-Vasallo, María D.; Hernández-Barrera, Valentín; Aragón‐Sánchez, Javier; Jiménez‐Trujillo, Isabel; Miguel‐Díez, Javier de; Palomar-Gallego, María A.; Romero-Maroto, Martín; Pérez-Farinós, Napoleón

doi:10.3390/jcm8101597

Cited by 14 publications

(16 citation statements)

References 55 publications

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“…Advanced age, African ethnicity and male sex are associated with an increased risk of amputations in patients with T2DM, while other factors such as female gender, kidney failure and congestive heart failure increase the risk of death during hospitalization [5]. In addition, undergoing a MA is a significant risk factor for long term mortality among T2DM patients [6].…”

Section: Introductionmentioning

confidence: 99%

“…In-hospital mortality due to amputations remained stable between 2001 and 2012, around 10%, resulting in an economic cost of 33% of the total cost spent in hospital treatment of T2DM complications [8]. Although there are several published works in relation to nontraumatic amputations in Spain [5][6][7][8], they account for the major and minor procedures globally in the analysis, or do not differentiate the type of diabetes. To our knowledge, there are no publications that have compared MA incidence in patients with T2DM in the seventeen Autonomous Communities (AACC) or Regions of Spain, nor analyzed possible regional heterogeneity in MA mortality or days of hospital stay.…”

Section: Introductionmentioning

confidence: 99%

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Major amputations in type 2 diabetes between 2001 and 2015 in Spain: regional differences

Pérez¹,

Chines

García³

et al. 2020

BMC Public Health

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Background: To analyze the trend of lower extremity major amputations (MA) among patients with type 2 diabetes mellitus (T2DM) in the Regions of Spain from year 2001 until 2015.Methods: Descriptive study of 40,392 MA. Data were obtained from the national hospital discharge database in patients with T2DM. The incidence rate was calculated in each Region, in addition to the incidence ratios (IR) between annual incidence and incidence of the year 2001. The length of hospital stay and mortality risks were analyzed using regression models adjusted for sex, age and smoking. Results: The major amputations incidence rate per 100,000 person-years was 0.48 in Spain; Canary Islands showed the highest incidence (0.81). The trend was a slight decrease or stability of the incidence in all Regions except in the Canary Islands (IR 2015 = 2.0 [CI95% = 1.5, 2.6]) and in Madrid (IR 2015 = 0.1 [CI95% = 0.1, 0.2]). Mortality after major amputations was 10% in Spain; Cantabria suffered the highest risk of death [1.7 (CI95% = 1.4; 2.1), p < 0.001] and La Rioja the lowest risk (0.5 [CI95% = 0.2; 0.9]; p = 0.026). The longest hospital stay was registered in the Canary Islands [(CI95% = 11.4;13.3], p < 0.001)], and the shortest in the Valencian Community [(CI95% = − 7.3; − 5.8), p < 0.001)]. Conclusion: MA in T2DM followed a growing trend in the Canary Islands, which diverged from the downward trend in Spain. The variability of mortality and hospital stay, suggest to review the clinical management in some Regions. Sudden incidence decrease in Madrid suggests checking the record procedures of hospital discharges.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Major amputations in type 2 diabetes between 2001 and 2015 in Spain: regional differences

Pérez¹,

Chines

García³

et al. 2020

BMC Public Health

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“…Co-existing microvascular disease (MVD) such as diabetes-related retinopathy and nephropathy increases the amputation risk, by more than 20 times 10 , 11 and death following amputation. 12 …”

Section: Introductionmentioning

confidence: 99%

Combining diabetic foot and retinopathy screening: A step in the right direction? – a feasibility study

et al. 2020

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Objectives: Peripheral artery disease is a major cardiovascular disease affecting more than 200 million people globally and up to 4 times more frequent in the diabetic population. It can lead to lower extremity amputations or revascularisation and is associated with an increased risk of myocardial infarction, stroke and early mortality. This novel cross-sectional study aimed to explore the feasibility and acceptability of incorporating diabetic foot screening at routine diabetic retinopathy screening appointments. Methods: Participants underwent foot screening during the interval between pupil dilatation and retinal photography as part of the eye screening procedure. Lower limb arterial assessment included ankle brachial index, pulse volume waveform and protective light touch sensation. Results: Of 364 participants invited, 88% (n = 321) met the inclusion criteria. About 26.4% (n = 86) had asymptomatic peripheral artery disease and 3% (n = 10) had peripheral sensory neuropathy. Binary logistical regression analysis identified age (p < 0.005), existing coronary heart disease (p < 0.005) and gender (p = 0.03) as predictors of peripheral artery disease. Conclusion: Incorporating foot examination during eye screening appointments is feasible and was well received by participants and staff alike. Undiagnosed early peripheral artery disease was evident in a third of the study population emphasising the benefit of introducing foot surveillance into eye screening appointments for the early identification of lower limb arterial disease and peripheral sensory neuropathy.

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“…[5] In addition, undergoing a MA is a significant risk factor for long term mortality among T2DM patients. [6] The overall incidence of amputations due to diabetes increased by 4.29% in Spain between 2001 and2004, followed by a downward trend until 2012, around 2%. [7] In-hospital mortality due to amputations remained stable between 2001 and 2012, around 10%, resulting in an economic cost of 33% of the total cost spent in hospital treatment of T2DM complications.…”

Section: Introductionmentioning

confidence: 99%

“…[7] In-hospital mortality due to amputations remained stable between 2001 and 2012, around 10%, resulting in an economic cost of 33% of the total cost spent in hospital treatment of T2DM complications. [8] Although there are several published works in relation to non-traumatic amputations in Spain [5][6][7][8], they account for the major and minor procedures globally in the analysis, or do not differentiate the type of diabetes. To our knowledge, there are no publications that have compared MA incidence in patients with T2DM in the seventeen Autonomous Communities (AACC) or Regions of Spain, nor analyzed possible regional heterogeneity in MA mortality or days of hospital stay.…”

Section: Introductionmentioning

confidence: 99%

Major amputations in type 2 diabetes between 2001 and 2015 in Spain: Regional differences.

Rodríguez-Pérez¹,

Chines²,

García³

et al. 2019

Preprint

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Background: To analyze the trend of lower extremity major amputations (MA) among patients with type 2 diabetes mellitus (T2DM) in the Regions of Spain from year 2001 until 2015. Methods :Descriptive study of 40,392 MA. Data were obtained from the national hospital discharge database in patients with T2DM. The incidence rate was calculated in each Region, in addition to the incidence ratios (IR) between annual incidence and incidence of the year 2001. The length of hospital stays and mortality risks were analyzed adjusting regression models for sex, age and smoking. Results: The major amputations incidence rate per 100,000 persons-year was 0.48 in Spain; Canary Islands showed the highest incidence (0.81). The trend was a slight decrease or stability of the incidence in all Regions except in the Canary Islands (IR 2015 = 2.0 CI95%= 1.5, 2.6) and in Madrid (IR 2015 = 0.1 CI95%=0.1, 0.2). Mortality after major amputations was 10% in Spain; Cantabria suffered the highest risk of death 1.7 (CI95%=1.4; 2.1), p<0.001 and La Rioja the lowest risk (0.5 CI95%=0.2; 0.9; p = 0.026). The longest hospital stay was registered in the Canary Islands (CI95%=11.4;13.3, p<0.001)], and the shortest in the Valencian Community (CI95%= -7.3; -5.8), p<0.001). Conclusion:MA in T2DM followed a growing trend in the Canary Islands, which diverged from the downward trend in Spain. The variability of mortality and hospital stay, suggest to review the clinical management in some Regions. Sudden incidence decrease in Madrid suggests checking the record procedures of hospital discharges.

show abstract

Time Trends in the Incidence of Long-Term Mortality in T2DM Patients Who Have Undergone a Lower Extremity Amputation. Results of a Descriptive and Retrospective Cohort Study

Cited by 14 publications

References 55 publications

Major amputations in type 2 diabetes between 2001 and 2015 in Spain: regional differences

Major amputations in type 2 diabetes between 2001 and 2015 in Spain: regional differences

Combining diabetic foot and retinopathy screening: A step in the right direction? – a feasibility study

Major amputations in type 2 diabetes between 2001 and 2015 in Spain: Regional differences.

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