Association between glycated haemoglobin and the risk of lower extremity amputation in patients with diabetes mellitus-review and meta-analysis
Association between glycated haemoglobin and the risk of lower extremity amputation in patients with diabetes mellitus-review and meta-analysis
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DOI：
10.1007/s00125-009-1638-7
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发表时间：
2010-05-01
期刊：
影响因子：
8.2
通讯作者：
Robinson, A. H. N.
中科院分区：
文献类型：
--
作者：
Adler, A. I.;Erqou, S.;Robinson, A. H. N.
糖尿病会增加下肢截肢（莱亚）的风险。尽管流行病学研究报告了高血糖和莱亚之间的正相关性，但风险的大小并没有充分量化，迄今为止的临床试验也没有提供关于血糖降低和莱亚风险的决定性证据。我们综合了关于糖尿病患者HbA（1c）测定的高血糖与莱亚风险之间关系的前瞻性流行病学数据，并检索了电子数据库和相关文献的参考列表。我们考虑了前瞻性流行病学研究，这些研究测量了HbA（1c）水平，并将莱亚评估为无急性足部溃疡或既往截肢史的糖尿病患者的结局。在识别的2,548篇引文中，我们纳入了14项研究，包括94,640名参与者和1,227例莱亚病例。我们使用标准化表格提取数据，并在需要时从研究者处获得数据。数据包括研究人群的特征、HbA（1c）测定方法、结局和协变量。采用随机效应模型荟萃分析汇总研究特异性相对风险估计值;采用荟萃回归分析探讨异质性。HbA（1c）每增加一个百分点，莱亚的总体RR为1.26（95%CI 1.16-1.36）。研究间存在相当大的异质性（I（2）76%，67-86%; p < 0.001），这并没有被记录的研究特征所解释。2型糖尿病的估计RR为1.44（95% CI 1.25-1.65），1型糖尿病为1.18（95% CI 1.02-1.38）;然而，差异无统计学意义（p = 0.09）。我们没有发现发表偏倚的强有力证据。糖尿病患者中与高血糖相关的莱亚风险显著增加。在缺乏来自试验的结论性证据的情况下，本文提供了进一步的流行病学支持，降糖作为一种策略，以减少截肢的人群中没有急性足溃疡或前截肢;它还提供了疾病建模估计，以评估高血糖症的总体负担。
Diabetes increases the risk of lower extremity amputation (LEA). Although epidemiological studies report positive associations between glycaemia and LEA, the magnitude of the risk is not adequately quantified and clinical trials to date have not provided conclusive evidence about glucose lowering and LEA risk. We synthesised the available prospective epidemiological data on the association between glycaemia measured by HbA(1c) and the risk of LEA in individuals with diabetes.We searched electronic databases and reference lists of relevant articles. We considered prospective epidemiological studies that had measured HbA(1c) level and assessed LEA as an outcome among diabetic individuals without acute foot ulcerations or previous history of amputation. Of 2,548 citations identified, we included 14 studies comprising 94,640 participants and 1,227 LEA cases. We abstracted data using standardised forms and obtained data from investigators when required. Data included characteristics of study populations, HbA(1c) assay methods, outcome and covariates. Study-specific relative risk estimates were pooled using random-effects model meta-analysis; heterogeneity was explored with meta-regression analyses.The overall RR for LEA was 1.26 (95% CI 1.16-1.36) for each percentage point increase in HbA(1c). There was considerable heterogeneity across studies (I (2) 76%, 67-86%; p < 0.001), which was not accounted for by recorded study characteristics. The estimated RR was 1.44 (95% CI 1.25-1.65) for type 2 diabetes and 1.18 (95% CI 1.02-1.38) for type 1 diabetes; however, the difference was not statistically significant (p = 0.09). We found no strong evidence for publication bias.There is a substantial increase in risk of LEA associated with glycaemia in individuals with diabetes. In the absence of conclusive evidence from trials, this paper provides further epidemiological support for glucose-lowering as a strategy to reduce amputation in a population without acute foot ulceration or former amputation; it also provides disease modellers with estimates to assess the overall burden of hyperglycaemia.