학술논문
Diabetes foot complications and standardized mortality rate in type 2 diabetes.
Document Type
Academic Journal
Author
Stedman M; RES Consortium, UK.; Robinson A; Department of Diabetes and Endocrinology, Salford Royal Foundation Trust, Salford, UK.; Dunn G; East Cheshire Trust, Macclesfield, UK.; Meza-Torres B; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.; Gibson JM; Department of Diabetes and Endocrinology, Salford Royal Foundation Trust, Salford, UK.; Department of Medicine, University of Manchester, Manchester, UK.; Reeves ND; Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.; Jude EB; Department of Medicine, University of Manchester, Manchester, UK.; Feher M; Chelsea and Westminster Hospital, London, UK.; Rayman G; The Ipswich Diabetes Centre and Research Unit, Ipswich Hospital NHS Trust, Ipswich, UK.; Whyte MB; Diabetic Foot Clinic, King's College Hospital Foundation Trust, London, UK.; Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.; Edmonds M; Diabetic Foot Clinic, King's College Hospital Foundation Trust, London, UK.; Heald AH; Department of Diabetes and Endocrinology, Salford Royal Foundation Trust, Salford, UK.; Department of Medicine, University of Manchester, Manchester, UK.
Source
Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 100883645 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1463-1326 (Electronic) Linking ISSN: 14628902 NLM ISO Abbreviation: Diabetes Obes Metab Subsets: MEDLINE
Subject
Language
English
Abstract
Aim: To quantify the impact of foot complications on mortality outcomes in people with type 2 diabetes (T2D), and how routinely measured factors might modulate that risk.
Materials and Methods: Data for individuals with T2D for 2010-2020, from the Salford Integrated Care Record (Salford, UK), were extracted for laboratory and clinical data, and deaths. Annual expected deaths were taken from Office of National Statistics mortality data. An index of multiple deprivation (IMD) adjusted the standardized mortality ratio (SMR_IMD). Life years lost per death (LYLD) was estimated from the difference between expected and actual deaths.
Results: A total of 11 806 T2D patients were included, with 5583 new diagnoses and 3921 deaths during 2010-2020. The number of expected deaths was 2135; after IMD adjustment, there were 2595 expected deaths. Therefore, excess deaths numbered 1326 (SMR_IMD 1.51). No foot complications were evident in n = 9857. This group had an SMR_IMD of 1.13 and 2.74 LYLD. In total, 2979 patients had any foot complication recorded. In this group, the SMD_IMR was 2.29; of these, 2555 (75%) had only one foot complication. Patients with a foot complication showed little difference in percentage HbA1c more than 58 mmol/mol. In multivariate analysis, for those with a foot complication and an albumin-to-creatinine ratio of more than 3 mg/mmol, the odds ratio (OR) for death was 1.93, and for an estimated glomerular filtration rate of less than 60 mL/min/1.73m2 , the OR for death was 1.92.
Conclusions: Patients with T2D but without a foot complication have an SMR_IMD that is only slightly higher than that of the general population. Those diagnosed with a foot complication have a mortality risk that is double that of those without T2D.
(© 2023 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)
Materials and Methods: Data for individuals with T2D for 2010-2020, from the Salford Integrated Care Record (Salford, UK), were extracted for laboratory and clinical data, and deaths. Annual expected deaths were taken from Office of National Statistics mortality data. An index of multiple deprivation (IMD) adjusted the standardized mortality ratio (SMR_IMD). Life years lost per death (LYLD) was estimated from the difference between expected and actual deaths.
Results: A total of 11 806 T2D patients were included, with 5583 new diagnoses and 3921 deaths during 2010-2020. The number of expected deaths was 2135; after IMD adjustment, there were 2595 expected deaths. Therefore, excess deaths numbered 1326 (SMR_IMD 1.51). No foot complications were evident in n = 9857. This group had an SMR_IMD of 1.13 and 2.74 LYLD. In total, 2979 patients had any foot complication recorded. In this group, the SMD_IMR was 2.29; of these, 2555 (75%) had only one foot complication. Patients with a foot complication showed little difference in percentage HbA1c more than 58 mmol/mol. In multivariate analysis, for those with a foot complication and an albumin-to-creatinine ratio of more than 3 mg/mmol, the odds ratio (OR) for death was 1.93, and for an estimated glomerular filtration rate of less than 60 mL/min/1.73m
Conclusions: Patients with T2D but without a foot complication have an SMR_IMD that is only slightly higher than that of the general population. Those diagnosed with a foot complication have a mortality risk that is double that of those without T2D.
(© 2023 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)