medwireNews: The risk for amputations in people with type 1 diabetes is in decline, but high glycated hemoglobin (HbA1c) levels and impaired renal function remain important risk factors, say researchers.
Overall, the standardized incidence of amputations declined over the study period, from 1998 to 2019, and this was the case for both major and minor amputations.
Speaking at the virtual ADA 81st Scientific Sessions, Sara Hallström (Sahlgrenska University Hospital, Gothenburg, Sweden) said this finding “indicates a shift in the prognosis of persons with type 1 diabetes.”
The study included 46,008 people with type 1 diabetes identified in Swedish national registers, 1509 of whom had undergone an amputation.
People with amputations were older than those who had not required one, with longer diabetes duration, higher HbA1c and blood pressure levels, lower estimated glomerular filtration rate (eGFR), and a higher rate of macroalbuminuria.
Macroalbuminuria had “the highest gradient of risk” associated with amputations, said Hallström, with each standard deviation (SD) increase associated with a significant 2.05-fold increase in risk for amputation after accounting for potential confounders.
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 renal function improved, on average, across the study period in people without amputations, whereas in those with amputations it remained stable until around 2015 and then declined sharply.
The average HbA1c level of the cohort decreased over time, and this was the case both for people with and without amputations. However, HbA1c levels were nearly 10 mmol/mol higher in people with than without amputations throughout the study period.
Each SD increase in HbA1c was independently associated with a significant 1.97-fold increase in risk for amputations.
Older age, higher systolic blood pressure, smoking, and the presence of cardiovascular disease were also significantly associated with amputation risk. However, Hallström stressed that macroalbuminuria and HbA1c had the strongest associations.
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