ArticleCardiovascular diabetology2022
Diabetes and other vascular risk factors in association with the risk of lower extremity amputation in chronic limb-threatening ischemia: a prospective cohort study.
Article in Cardiovascular diabetology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
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Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- The incidence of surgical site infection following major lower limb amputation: A systematic review.International wound journal · 2024Pooled it
- Vitamin D and Risk of Incident Type 2 Diabetes in Older Adults: An Updated Systematic Review and Meta-Analysis.Nutrients · 2024Pooled it
- A novel therapeutic management for diabetes patients with chronic limb-threatening ischemia: comparison of autologous bone marrow mononuclear cells versus allogenic Wharton jelly-derived mesenchymal stem cells.Stem cell research & therapy · 2023Trial
- Blood pressure parameters and the risk of chronic limb-threatening ischemia: The Singapore Chinese Health Study.Journal of vascular surgery · 2026Article
- Article
- Global, regional, and national burden of lower extremity peripheral arterial disease: a systematic analysis of prevalence, incidence, deaths, and dalys from 1990 to 2021 with projections and dietary risk factors to 2036.Journal of health, population, and nutrition · 2025Article
- Exploring optimal analgesic strategies for chronic limb-threatening ischaemia: a systematic review protocol.BMJ open · 2025Article
- miR-200c inhibition and catalase accelerate diabetic wound healing.Journal of biomedical science · 2025Article
- Incense Use and the Risk of Chronic Limb-Threatening Ischemia Among Middle-Aged and Older Adults in the Singapore Chinese Health Study.Environmental health perspectives · 2025Article
- Article
- Lesion Localization and Limb Outcomes in Elderly Patients with and Without Type 2 Diabetes Mellitus Who Undergo Atherectomy-Assisted Endovascular Revascularization due to Symptomatic Peripheral Artery Disease.Journal of clinical medicine · 2024Article
- Consumption of different types of meat and the risk of chronic limb-threatening ischemia: the Singapore Chinese Health Study.Nutrition journal · 2024Article
- Management of Microcomplications of Diabetes Mellitus: Challenges, Current Trends, and Future Perspectives in Treatment.Biomedicines · 2024Review
- The Potential of Anti-Inflammatory DC Immunotherapy in Improving Proteinuria in Type 2 Diabetes Mellitus.Vaccines · 2024Review
- Prognostic Nutritional Index as a New Prediction Tool for All-Cause Mortality in Patients with Chronic Limb-Threatening Ischemia Undergoing Endovascular Therapy.Sisli Etfal Hastanesi tip bulteni · 2024Article
- Clinical Potential of Hydrogen Sulfide in Peripheral Arterial Disease.International journal of molecular sciences · 2023Review
- Focus on the Prevention of Acute Limb Ischemia: Centrality of the General Practitioner from the Point of View of the Internist.Journal of clinical medicine · 2023Review
- Real-world risk of lower-limb amputation associated with sodium-glucose cotransporter 2 inhibitors versus metformin: A propensity score-matched model analysis in Japan.Journal of diabetes investigation · 2022 · on this mapObservational
- Temporal trends in patients with peripheral artery disease influenced by diabetes mellitus in Germany.Journal of diabetes · 2022Article
- BAG3 Attenuates Ischemia-Induced Skeletal Muscle Necroptosis in Diabetic Experimental Peripheral Artery Disease.International journal of molecular sciences · 2022Article
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Authors and funding
6 authors at 3 institutions in 3 countries.
Funding
Abstract
backgroundPatients with diabetes are at increased risk of developing chronic limb-threatening ischemia (CLTI) due to peripheral arterial disease, and this often results in lower extremity amputation (LEA). Little is known of the interaction between diabetes and other vascular risk factors in affecting the risk of CLTI.
methodsWe investigated the association of diabetes, and its interaction with hypertension, body mass index (BMI) and smoking, with the risk of LEA due to CLTI in the population-based Singapore Chinese Health Study. Participants were interviewed at recruitment (1993-1998) and 656 incident LEA cases were identified via linkage with nationwide hospital database through 2017. Multivariate-adjusted Cox proportional hazards models were used to compute hazard ratios (HRs) and 95% CIs for the associations.
resultsThe HR (95% CI) for LEA risk was 13.41 (11.38-15.79) in participants with diabetes compared to their counterparts without diabetes, and the risk increased in a stepwise manner with duration of diabetes (P for trend < 0.0001). Hypertension and increased BMI independently increased LEA risk in those without diabetes but did not increase the risk in those with diabetes (P for interaction with diabetes ≤ 0.0006). Conversely, current smoking conferred a risk increment of about 40% regardless of diabetes status.
conclusionsAlthough diabetes conferred more than tenfold increase in risk of LEA, hypertension and increased BMI did not further increase LEA risk among those with diabetes, suggesting a common mechanistic pathway for these risk factors. In contrast, smoking may act via an alternative pathway and thus confer additional risk regardless of diabetes status.
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