Incidence of lower extremity amputations among patients with type 1 and type 2 diabetes in the United States from 2010 to 2014
Incidence of lower extremity amputations among patients with type 1 and type 2 diabetes in the United States from 2010 to 2014
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DOI：
10.1111/dom.14012
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发表时间：
2020-07-01
影响因子：
5.8
通讯作者：
Lavery, Lawrence A.
中科院分区：
文献类型：
--
作者：
Deruaz-Luyet, Anouk;Raabe, Christina;Lavery, Lawrence A.
目的使用美国商业声明比较1型糖尿病（T1 D）患者和2型糖尿病（T2 D）患者与非糖尿病患者的下肢截肢（莱亚）发生率，并评估发生莱亚时是否存在关键合并症和促发因素。方法通过IBM MarketScan研究数据库定义2010-2014年期间T1 D和T2 D受益人的队列。对于每例T1 D和T2 D患者，随机选择1例在日历时间、性别和年龄上匹配的既往无糖尿病声明的患者。多变量考克斯比例风险模型用于估计校正的风险比（aHR）和95%置信区间。结果在120 129例T1 D患者和170万T2 D患者的匹配队列中，T1 D患者的莱亚发生率高于T2 D患者，最常见的病例是轻微LEA（分别为4.85和1.53/1000患者年[PY]），主要是脚趾截肢（分别为4.49和1.43/1000 PY）。与年龄、性别和日历时间匹配的非糖尿病患者相比，T1 D和T2 D患者的合并症更多，莱亚发生率更高（6.02 vs. 0.14/1000 PY; aHR，22.47 [16.42-30.73]和1.90 vs. 0.23/1000 PY; aHR，4.64 [4.32-4.98]）。结论我们的数据显示，与非糖尿病患者相比，T1 D和T2 D患者的莱亚发生率更高，尤其是轻微莱亚，T1 D患者的风险高于T2 D患者。考虑到莱亚的已知和可测量的风险因素，相对风险降低了近50%;大多数莱亚病例为轻微LEA和脚趾截肢。
Aim To compare the incidence of lower extremity amputation (LEA) among patients with type 1 diabetes (T1D) and patients with type 2 diabetes (T2D) with those without diabetes using US commercial claims and to assess the presence of key co-morbidities and precipitating factors at the time of the LEA. Methods Cohorts were defined via IBM MarketScan research databases for beneficiaries with T1D and T2D during 2010-2014. For each T1D and T2D patient, one patient without a prior diabetic claim matched on calendar time, sex and age, was randomly selected. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals. Results Among the matched cohorts of 120 129 T1D patients and 1.7 million T2D patients, the incidence of LEA was higher among patients with T1D than patients with T2D, with the most frequent cases being minor LEAs (4.85 and 1.53 per 1000 patient years [PY], respectively), largely toe amputations (4.49 and 1.43 per 1000 PY, respectively). Compared with non-diabetic patients matched on age, sex and calendar time, T1D and T2D patients had more co-morbidities and a higher incidence of LEA (6.02 vs. 0.14 per 1000 PY; aHR, 22.47 [16.42-30.73] and 1.90 vs. 0.23 per 1000 PY; aHR, 4.64 [4.32-4.98]). Conclusions Our data showed a higher incidence of LEA, especially minor LEA, in patients with T1D and T2D compared with those without diabetes, with a greater risk among patients with T1D than patients with T2D. Accounting for known and measurable risk factors for LEA reduced the relative hazard by nearly 50%; the majority of LEA cases were minor LEAs and toe amputations.