Temporal trends in non-traumatic lower extremity amputations (LEAs) and their association with 12-month mortality in people with diabetes, 2004-2016.

To assess trends in hospital admissions for non-traumatic lower extremity amputations (LEAs) and for mortality following LEAs in adult patients with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) admitted to hospitals in Victoria, Australia during 2004-2016. Using hospital discharge data, we calculated age- and sex- adjusted admission rates for incident cases of any LEA, minor LEAs, major LEAs and 12-month mortality following any LEAs for patients according to diabetes type. Joinpoint regression analysis was used to identify changes in linear trends that were described as average annual percentage change (AAPC). Significant declines in rates of admission for any LEA (AAPC -4.9), minor LEAs (-3.0 %) and major LEAs (AAPC -11.5 %) were seen for patients with T2DM. Overall, admission rates for any LEA did not significantly change for patients with T1DM during 2004 and 2016, however, we detected a significant rise in admissions for any LEAs (AAPC +5.1) in female patients with T1DM. This increase was most prominent in younger (<60 years) patients undergoing minor LEAs. During 2009-2016, younger patients with type 1 DM, regardless of sex, also experienced significant increases in admissions for any LEA (AAPC +14) and major LEAs (AAPC +15). Mortality associated with LEAs in T2DM declines, with a 12-month mortality rate of 6.3 %) associated with LEAs in T2M decline (AAPC -4.2 %) whereas rates for T1DM remained stable (1.9 %) during 2004-2016. There were significant differences in LEA hospital admission trends by type of diabetes, age and sex. The decline in LEAs and its associated mortality is welcome news for patients with T2DM. However, reasons for the increase in LEAs in younger patients with T1DM remain to be determined.

Kiburg KV ，Galligan A ，Sundararajan V ，MacIsaac RJ ... -  《-》

National trends in incidence and outcomes in lower extremity amputations in people with and without diabetes in Spain, 2001-2012.

To describe trends in the incidence and outcomes of lower-extremity amputations (LEAs) in patients with T1DM and T2DM in Spain, 2001-2012. We used national hospital discharge data. Incidence of discharges attributed to LEA procedures were calculated stratified by diabetes status and type of LEA. Joinpoint log-linear regression for incidence trends and logistic regression for factors associated with in-hospital mortality were used. From 2001 to 2012, 73,302 minor LEAs and 64,710 major LEAs were performed. We found that incidence of minor LEA procedures in T1DM patients decreased by 9.84% per year from 2001 to 2008 and then remained stable through 2012. In T2DM patients, LEA increased by 1.89% per year over the entire study period. Among patients with T1DM, major LEA incidence rate decreased by 10.5% from 2001 to 2012. In patients with T2DM, it increased by 4.29% from 2001 to 2004, and then decreased by 1.85% through 2012. In-hospital mortality after major or minor LEAs was associated with older age in all groups and with being female in T2DM and in people without diabetes. Our national data show a decrease in the incidence of minor LEAs in patients with diabetes and in major LEAS in patients with T1DM over the period of study. In patients with T2DM, we found a decrease between 2004 and 2012. An additional improvement in preventive care, such as the introduction of diabetes foot units in hospitals, is necessary.

Lopez-de-Andres A ，Jiménez-García R ，Aragón-Sánchez J ，Jiménez-Trujillo I ，Hernández-Barrera V ，Méndez-Bailón M ，de Miguel-Yanes JM ，Perez-Farinos N ，Carrasco-Garrido P ... -  《-》

Diabetes-Related Lower Extremity Amputations in Romania: Patterns and Changes between 2015 and 2019.

Coman H ，Stancu B ，Gâvan NA ，Bowling FL ，Podariu L ，Bondor CI ，Radulian G ... -  《-》

Secular trends in rates of hospitalisation for lower extremity amputation and 1 year mortality in people with diabetes in Hong Kong, 2001-2016: a retrospective cohort study.

Wu H ，Yang A ，Lau ESH ，Ma RCW ，Kong APS ，Chow E ，So WY ，Chan JCN ，Luk AOY ... -  《-》

Time trends (2001-2019) and sex differences in incidence and in-hospital mortality after lower extremity amputations among patients with type 1 diabetes in Spain.

We examined trends in incidence (2001-2019), clinical characteristics, and in-hospital outcomes following major and minor lower extremity amputations (LEAs) among type 1 diabetes mellitus (T1DM) patients in Spain and attempted to identify sex differences. Retrospective cohort study using data from the Spanish National Hospital Discharge Database. We estimated the incidence of the LEA procedure stratified by type of LEA. Joinpoint regression was used to estimate incidence trends, and logistic regression was used to estimate factors associated with in-hospital mortality (IHM). LEA was coded in 6011 patients with T1DM (66.4% minor and 33.6% major). The incidence of minor LEA decreased by 9.55% per year from 2001 to 2009 and then increased by 1.50% per year, although not significantly, through 2019. The incidence of major LEA decreased by 13.39% per year from 2001 to 2010 and then remained stable through 2019. However, incidence increased in men (26.53% per year), although not significantly, from 2017 to 2019. The adjusted incidence of minor and major LEA was higher in men than in women (IRR 3.01 [95% CI 2.64-3.36] and IRR 1.85 [95% CI 1.31-2.38], respectively). Over the entire period, for those who underwent a minor LEA, the IHM was 1.58% (2.28% for females and 1.36% for males; p = 0.045) and for a major LEA the IHM was 8.57% (10.52% for females and 7.59% for males; p = 0.025). IHM after minor and major LEA increased with age and the presence of comorbid conditions such as peripheral arterial disease, ischemic heart disease or chronic kidney disease. Female sex was associated with a higher IHM after major LEA (OR 1.37 [95% CI 1.01-1.84]). Our data show a decrease in incidence rates for minor and major LEA in men and women with T1DM and a slight, albeit insignificant, increase in major LEA in men with T1DM in the last two years of the study. The incidence of minor and major LEA was higher in men than in women. Female sex is a predictor of IHM in patients with T1DM following major LEA.

Lopez-de-Andres A ，Jimenez-Garcia R ，Hernández-Barrera V ，de-Miguel-Diez J ，de-Miguel-Yanes JM ，Omaña-Palanco R ，Carabantes-Alarcon D ... -  《Cardiovascular Diabetology》