title: Subsequent ischemic events associated with lower extremity amputations in patients with type 2 diabetes: a population-based cohort study.
abstract: OBJECTIVE
  To explore the risk of subsequent ischemic events in type 2 diabetes mellitus (DM) patients who had lower extremity amputations (LEAs) were compared with DM patients without LEAs.
  
  
  METHODS
  A population-based cohort study was conducted utilizing the data of 2011 patients with newly diagnosed DM with and without LEAs sourced from the Longitudinal Health Insurance Database 2000 (LHID 2000) of the Taiwan National Health Insurance (NHI) program between 1996 and 2008.
  
  
  METHODS
  Relative risks (RRs), hazard ratios (HRs), and disease-free rates for various ischemic events.
  
  
  RESULTS
  In contrast with the comparison group, subjects with LEAs were more likely to reside in less urbanized areas, be white collar workers, and have higher DM-related costs (p<0.05). Subjects with LEAs also had significantly higher risks of developing ischemic diseases, except intestinal ischemia. In the multivariate Cox proportional hazards regression model analysis, the HR of end-stage renal disease (ESRD) was highest (HR=3.91, 95% CI=2.38-6.42), followed by embolism and thrombosis (HR=3.47, 95% CI=2.12-5.67), other peripheral vascular diseases (HR=3.11, 95% CI=2.11-4.57), atherosclerosis (HR=2.64, 95% CI=1.60-4.35), retinopathy (HR=2.24, 95% CI=1.79-2.80), cerebral ischemia (HR=1.61, 95% CI=1.25-2.06), and coronary artery disease (HR=1.44, 95% CI=1.18-1.74).
  
  
  CONCLUSIONS
  DM patients with LEAs had significantly higher risks for subsequent ischemic events, particularly among men. The greatest risk detected among DM patients with LEA's was for end-stage renal disease. Disease free survival rates also indicated that the course of generalized DM ischemia proceeded despite treatment.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Feng-Chou
authors.initials: FC
authors.lastname: Tsai
authors.affiliation: Department of Health Risk Management, China Medical University, Taichung, Taiwan; Management Office for Health Data, Graduate Institute of Clinical Medical Science, China Medical University and Hospital, Taichung, Taiwan.
authors.forename: Yu-Ching
authors.initials: YC
authors.lastname: Lan
authors.affiliation: Management Office for Health Data, Graduate Institute of Clinical Medical Science, China Medical University and Hospital, Taichung, Taiwan.
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Muo
authors.affiliation: Division of Nephrology, China Medical University and Hospital, Taichung, Taiwan.
authors.forename: Ya-Fei
authors.initials: YF
authors.lastname: Yang
authors.affiliation: Management Office for Health Data, Graduate Institute of Clinical Medical Science, China Medical University and Hospital, Taichung, Taiwan.
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
authors.affiliation: School of Public Health, Taipei Medical University, Taipei, Taiwan. Electronic address: rueyyu@tmu.edu.tw.
authors.forename: Ruey-Yu
authors.initials: RY
authors.lastname: Chen
authors.affiliation: School of Public Health, Taipei Medical University, Taipei, Taiwan. Electronic address: sylyu@tmu.edu.tw.
authors.forename: Shu-Yu
authors.initials: SY
authors.lastname: Lyu
authors.affiliation: Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Morisky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000453:epidemiology* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications; D035002:Lower Extremity / Q000098:blood supply / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016491:Peripheral Vascular Diseases / Q000209:etiology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
keywords: Diabetes; Ischemia; Lower extremity amputation