Reamputation risk and mortality after lower-limb amputation in patients with diabetes: predictors, effects of antidiabetic medications and temporal trends
Main findingResult — go to the resultHazard ratio 1.28 95% CI 1.08–1.52Authors' conclusion
Diabetes remains to be associated with reduced reamputation-free survival; an association that is independent of increased prevalence of comorbidities in our data. Although reamputation risk has increased in recent years, overall survival has improved in patients with diabetes. Metformin usage is associated with improved reamputation-free survival while our limited data suggest increased risk of reamputation but safety with respect to mortality in patients treated with SGLT2i. Further studies are warranted to evaluate the effect of SGLT2i therapy on outcome in patients undergoing LLA.
Study context
- Population
- Patients undergoing non-traumatic lower limb amputation (LLA), 2006–2022
- Participants
- 607 vs 500
- Exposure
- Diabetes vs no diabetes
- Diabetesn = 607
- No diabetesn = 500reference
- Outcome
- Reamputation-free survival
Methodological detailsCox regression, joint frailty models
- Cox regression
- Joint frailty models
Main finding
As reported in the abstract
Hazard ratio
1.28
95% CI 1.08–1.52
P = 0.004
Observational data: associations, not effects.
Further findings
Metformin use in T2D: combined reamputation and mortality risk
| HR (95% CI) | P value | ||
|---|---|---|---|
| Metformin | 0.59 (0.43–0.81) | P = 0.001 | |
| 0.512Hazard ratio (log scale) |
SGLT2i use: reamputation risk
| HR (95% CI) | P value | ||
|---|---|---|---|
| SGLT2i | 2.00 (1.47–2.72) | P > 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
Predictors of reamputation-free survival / reamputation in diabetes
- Higher HbA1c associated with lower reamputation-free survival
- Older age, AF and CKD associated with increased reamputation risk
SGLT2i use: reamputation risk
- SGLT2i use was low overall; safe with respect to mortality
Temporal trends in diabetes
- Reamputation risk peaked in 2020–2022; mortality declined vs 2006–2010
Original publication
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