Observational studyDiabetologia2021
Diabetes-related lower extremity complications in a multi-ethnic Asian population: a 10 year observational study in Singapore.
Observational study in Diabetologia, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.
- Prevalence and Presentation of Lower Limb Neurovascular Complications in Children With Diabetes: A Systematic Review With Proportion Meta-Analysis.Pediatric diabetes · 2025Pooled it
- Cognitive changes in people with diabetes with lower extremity complications compared to people with diabetes without lower extremity complications: a systematic review and meta-analysis.BMC endocrine disorders · 2024Pooled it
- The burden of diabetic foot ulcers in a multi-ethnic Asian cohort.Diabetic medicine : a journal of the British Diabetic Association · 2026Observational
- Article
- Diabetes-related foot complications and caregiver burden: insights from a cross-sectional study in multi-ethnic Asians.Journal of global health · 2026Article
- Role of social determinants, lifestyle and clinical factors in the development of diabetic peripheral neuropathy among a multiethnic Asian population in Singapore: a retrospective analysis.BMJ public health · 2026Article
- Diabetes-Related Foot Disease in South Asians Living in Western Countries: Burden, Outcomes, and Gaps in the Literature-A Scoping Review Protocol.International wound journal · 2025Article
- Retrospective analysis of value-driven outcomes of diabetic foot ulcer in a tertiary hospital in Singapore.BMJ open · 2025Article
- Cost-effectiveness of ON101 with general wound care for diabetic foot ulcers among patients with type 2 diabetes in Singapore: Analysis of a multi-ethnic country in Asia.Diabetes, obesity & metabolism · 2025Article
- Socioeconomic and ethnic disparities in major lower limb amputation related to peripheral arterial disease in England.BJS open · 2025Article
- Atherectomy in the Treatment of Peripheral Arterial Disease-A Case Series to Demonstrate Preferable Indications with Good Outcomes and a Literature Review.Journal of clinical medicine · 2025Article
- Article
- Epidemiology and Burden of Peripheral Artery Disease in People With Type 2 Diabetes: A Systematic Literature Review.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2024Review
- Foot care behaviours and associated factors among patients with type 2 diabetes: A cross-sectional study.Journal of global health · 2024Article
- Diabetic foot in primary and tertiary (DEFINITE) Care: A health services innovation in coordination of diabetic foot ulcer (DFU) Care within a healthcare cluster - 18-month results from an observational population health cohort study.International wound journal · 2023Observational
- Temporal trends in patients with peripheral artery disease influenced by diabetes mellitus in Germany.Journal of diabetes · 2022Article
Corrections and comments
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Authors and funding
10 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aims/hypothesisDiabetes progression and complication risk are different in Asian people compared with those of European ancestry. In this study, we sought to understand the epidemiology of diabetes-related lower extremity complications (DRLECs: symptomatic peripheral arterial disease, ulceration, infection, gangrene) and amputations in a multi-ethnic Asian population.
methodsThis was a retrospective observational study using data obtained from one of three integrated public healthcare clusters in Singapore. The population consisted of individuals with incident type 2 diabetes who were of Chinese, Malay, Indian or Other ethnicity. We examined incidence, time to event and risk factors of DRLECs and amputation.
resultsBetween 2007 and 2017, of the 156,593 individuals with incident type 2 diabetes, 20,744 developed a DRLEC, of whom 1208 underwent amputation. Age- and sex-standardised incidence of first DRLEC and first amputation was 28.29/1000 person-years of diabetes and 8.18/1000 person-years of DRLEC, respectively. Incidence of both was highest in individuals of Malay ethnicity (DRLEC, 36.09/1000 person-years of diabetes; amputation, 12.96/1000 person-years of DRLEC). Median time from diabetes diagnosis in the public healthcare system to first DRLEC was 30.5 months for those without subsequent amputation and 10.9 months for those with subsequent amputation. Median time from DRLEC to first amputation was 2.3 months. Older age (p < 0.001), male sex (p < 0.001), Malay ethnicity (p < 0.001), Indian ethnicity (p = 0.014), chronic comorbidities (nephropathy [p < 0.001], heart disease [p < 0.001], stroke [p < 0.001], retinopathy [p < 0.001], neuropathy [p < 0.001]), poorer or missing HbA CONCLUSIONS/
interpretationThis study has revealed important ethnic differences in risk of diabetes-related lower limb complications, with Malays most likely to progress to DRLEC. Greater research efforts are needed to understand the aetiopathological and sociocultural processes that contribute to the higher risk of lower extremity complications among these ethnic groups.
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