Evidence map›Paper›PMID 34494137›Full record

Observational studyDiabetologia2021

Risk factors and incidence over time for lower extremity amputations in people with type 1 diabetes: an observational cohort study of 46,088 patients from the Swedish National Diabetes Registry.

Sara Hallström, Ann-Marie Svensson, Aldina Pivodic, Arndís F Ólafsdóttir, Magnus Löndahl, Hans Wedel, Marcus Lind

Open access · hybridAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

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 17 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 2 pooled it
4.5field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 2 syntheses or guidelines pooled it, 36 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Observational
  4. Article
  5. Review
  6. Article
  7. Article
  8. Article
  9. Observational
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Observational
  17. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 5 institutions in 1 country.

Sara HallströmDepartment of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. sara.el.nilsson@vgregion.se.ORCID 0000-0002-1119-5267
Ann-Marie SvenssonDepartment of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.ORCID 0000-0001-8121-2045
Aldina PivodicDepartment of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.ORCID 0000-0002-2224-3236
Arndís F ÓlafsdóttirDepartment of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.ORCID 0000-0002-2083-2512
Magnus LöndahlDepartment of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.ORCID 0000-0003-1522-3920
Hans WedelDepartment of Health Metrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.ORCID 0000-0001-7571-0021
Marcus LindDepartment of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.ORCID 0000-0002-3796-9283
NU Hospital Group · SEUniversity of Gothenburg · SELund University · SERegion Västra Götaland · SESahlgrenska University Hospital · SE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aims/hypothesisThe aim of this work was to study the incidence over time of lower extremity amputations and determine variables associated with increased risk of amputations in people with type 1 diabetes.

methodsIndividuals with type 1 diabetes registered in the Swedish National Diabetes Registry with no previous amputation from 1 January 1998 and followed to 2 October 2019 were included. Time-updated Cox regression and gradient of risk per SD were used to evaluate the impact of risk factors on the incidence of amputation. Age- and sex-adjusted incidences were estimated over time.

resultsOf 46,088 people with type 1 diabetes with no previous amputation (mean age 32.5 years [SD 14.5], 25,354 [55%] male sex), 1519 (3.3%) underwent amputation. Median follow-up was 12.4 years. The standardised incidence for any amputation in 1998-2001 was 2.84 (95% CI 2.32, 3.36) per 1000 person-years and decreased to 1.64 (95% CI 1.38, 1.90) per 1000 person-years in 2017-2019. The incidence for minor and major amputations showed a similar pattern. Hyperglycaemia and renal dysfunction were the strongest risk factors for amputation, followed by older age, male sex, cardiovascular comorbidities, smoking and hypertension. Glycaemic control and age- and sex-adjusted renal function improved during the corresponding time period as amputations decreased. CONCLUSIONS/

interpretationThe incidence of amputation and of the most prominent risk factors for amputation, including renal dysfunction and hyperglycaemia, has improved considerably during recent years for people with type 1 diabetes. This finding has important implications for quality of life, health economics and prognosis regarding CVD, indicating a trend shift in the treatment of type 1 diabetes.

Indexed as

Diabetes Mellitus, Type 1Diabetes Mellitus, Type 2Diabetic FootAdultAmputation, SurgicalCohort StudiesHumansIncidenceLower ExtremityMaleQuality of LifeRegistriesRisk FactorsSwedenAmputationCardiovascular diseaseEpidemiologyHbA1cLower-extremity amputationRisk factorsType 1 diabetes

Identifiers

PMID34494137
PMCPMC8563633
OpenAlexW3196985919

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.