medwireNews: The risk of amputation in people with type 1 diabetes is declining, but high levels of glycated hemoglobin (HbA1c) and impaired kidney function remain important risk factors, researchers say.
Overall, the standardized incidence of amputations decreased in the study period from 1998 to 2019, both for major and minor amputations.
Speaking at the ADA’s 81st virtual scientific sessions, Sara Hallström (Sahlgrenska University Hospital, Gothenburg, Sweden) said this finding “indicates a shift in the prognosis of people with type 1 diabetes”.
The study enrolled 46,008 people with type 1 diabetes identified in Swedish national registries, of whom 1509 had an amputation.
People with amputations were older than those who did not need an amputation, with longer diabetes duration, higher HbA1c and blood pressure levels, lower estimated glomerular filtration rate (eGFR), and higher rate of macroalbuminuria.
Macroalbuminuria has “the highest risk gradient” associated with amputations, Hallström said, with any increase in standard deviation (SD) associated with a significant 2.05-fold increase in amputation risk after potential confounders were considered.
Each SD increase in microalbuminuria was associated with a significant 1.46-fold increase in risk, and each SD decrease in eGFR was associated with a significant 1.69-fold increase.
The team found that kidney function in people without an amputation improved on average over the study period, while in people with amputations it remained stable until around 2015 and then fell sharply.
The cohort’s mean HbA1c levels decreased over time, and this was the case in both amputated and non-amputated people. However, the HbA1c values in people with amputations were almost 10 mmol / mol higher during the entire study period.
Each SD increase in HbA1c was independently associated with a significant 1.97-fold increase in amputation risk.
Older age, higher systolic blood pressure, smoking, and the presence of cardiovascular disease were also significantly linked to the risk of amputation. However, Hallström emphasized that macroalbuminuria and HbA1c have the strongest associations.
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Scientific meetings of the ADA; 25-29 June 2021
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