Aims
Diabetic foot ulcer (DFU) is a leading cause of lower limb amputations in people with diabetes. This study was aimed to retrospectively analyze factors affecting DFU using real‐world data from a ...large, prospective central‐European diabetes registry (DPV Diabetes‐Patienten‐Verlaufsdokumentation).
Materials and Methods
We matched adults with type 1 (T1D) or type 2 diabetes (T2D) and DFU to controls without DFU by diabetes type, age, sex, diabetes duration, and treatment year to compare possible risk factors. Cox regression was used to calculate hazard ratios for amputation among those with DFU.
Results
In our cohort (N = 63 464), male sex, taller height, and diabetes complications such as neuropathy, peripheral artery disease, nephropathy, and retinopathy were associated with DFU (all p < .001). Glycated hemoglobin (HbA1c) was related to DFU only in T1D (mean with 95% confidence interval CI: 7.8 6.9–9.0 % vs 7.5 6.8–8.5 %, p < .001). High triglycerides and worse low‐density lipoprotein/high‐density lipoprotein ratio were also associated with DFU in T1D, whereas smoking (14.7% vs 13.1%) and alcohol abuse (6.4% vs 3.8%, both p < .001) were associated with DFU in T2D. Male sex, higher Wagner grades, and high HbA1c in both diabetes types and insulin use in T2D were associated with increased hazard ratios for amputations.
Conclusions
Sex, body height, and diabetes complications were associated DFU risk in adults with T1D and T2D. Improvement in glycemic control and lipid levels in T1D and reduction of smoking and drinking in T2D may be appropriate interventions to reduce the risk for DFU or amputations.
Highlights
Poor glycemic control and high lipid levels were associated more closely with diabetic foot ulcers in type 1 compared to type 2 diabetes.
Gender differences regarding the association of diabetic foot ulcers with metabolic outcomes were more pronounced in type 1 diabetes.
Smoking and alcohol consumption might be important in developing foot ulcers but play a minor role in prevention of amputations.
The role of oral hypoglycemic medication in development of diabetic foot ulcers should be further analyzed in type 2 diabetes.
Aims
The diabetic foot syndrome (DFS) is a serious complication in patients with diabetes increasing the risk for minor/major amputations. This analysis aimed to examine differences in diabetes ...patients with or without DFS stratified by type 1 (T1D) or type 2 diabetes (T2D).
Material and Methods
Adult patients (≥20y of age) with diabetes from the German/Austrian diabetes patients follow‐up registry (DPV) were included. The cross‐sectional study comprised 45 722 subjects with T1D (nDFS = 2966) and 313 264 with T2D (nDFS = 30 904). In DFS, minor/major amputations were analysed. To compare HbA1C, neuropathy, nephropathy, cardiovascular disease risk factors, and macrovascular complications between patients with or without DFS, regression models were conducted. Confounders: age, sex, diabetes duration.
Results
In patients with DFS, a minor amputation was documented in 27.2% (T1D) and 25.9% (T2D), a major amputation in 10.2% (T1D) and 11.3% (T2D). Regression models revealed that neuropathy was more frequent in subjects with DFS compared with patients without DFS (T1D: 70.7 vs 29.8%; T2D: 59.4% vs 36.9%; both P < 0.0001). Hypertension, nephropathy, peripheral vascular disease, stroke, or myocardial infarction was more common compared with patients without DFS (all P < 0.0001). In T1D with DFS, a slightly higher HbA1C (8.11% vs 7.95%; P < 0.0001) and in T2D with DFS a lower HbA1C (7.49% vs 7.69%; P < 0.0001) was observed.
Conclusions
One third of the patients with DFS had an amputation of the lower extremity. Especially neuropathy or peripheral vascular disease was more prevalent in patients with DFS. New concepts to prevent DFS‐induced amputations and to reduce cardiovascular risk factors before the occurrence of DFS are necessary.
Background
To describe checkpoint inhibitor‐induced diabetes mellitus (CPI‐DM) and to compare with regular type 1 (T1DM), type 2 (T2DM), and medication‐induced diabetes mellitus (MI‐DM).
Methods
We ...included 88 177 adult patients from the Diabetes Patient Follow‐Up (DPV) registry with diabetes manifestation between 2011 and 2020. Inclusion criteria were T1DM, T2DM, MI‐DM, or CPI‐DM. Because of the heterogeneity between the groups, we matched patients by age, sex, and diabetes duration using propensity scores. Patient data were aggregated in the respective first documented treatment year.
Results
The matched cohort consisted of 24 164 patients; T1DM: 29, T2DM: 24000, MI‐DM: 120, CPI‐DM: 15 patients. Median age at manifestation of CPI‐DM patients was 63.6 (57.2‐72.8) years (53.3% male). Body mass index in CPI‐DM patients was significantly lower (26.8 23.9‐28.1 kg/m2) compared with T2DM patients (29.8 26.2‐34.3 kg/m2, P = 0.02). At manifestation, HbA1c was significantly higher in CPI‐DM compared with MI‐DM, but there was no difference during follow‐up. Diabetic ketoacidosis (DKA) was documented in six CPI‐DM patients (T1DM: 0%, T2DM: 0.4%, MI‐DM: 0.0%). Fourteen CPI‐DM patients were treated with insulin, and three received additional oral antidiabetics. The most common therapy in T2DM was lifestyle modification (38.8%), insulin in MI‐DM (52.5%). Concomitant autoimmune thyroid disease was present in four CPI‐DM patients (T1DM: 0.0%, T2DM: 1.0%, MI‐DM: 0.8%).
Conclusions
The data from this controlled study show that CPI‐DM is characterized by a high prevalence of DKA, autoimmune comorbidity, and metabolic decompensation at onset. Structured diagnostic monitoring is warranted to prevent DKA and other acute endocrine complications in CPI‐treated patients.
摘要
背景
了解检查点抑制剂诱导的糖尿病(CPI‐DM)与普通1型糖尿病(T1 DM)、2型糖尿病(T2 DM)和药物诱导的糖尿病(MI‐DM)的异同。
方法
我们纳入了2011年至2020年间来自糖尿病患者随访(DPV)登记处的88177名有糖尿病表现的成年患者。纳入标准为T1 DM、T2 DM、MI‐DM或CPI‐DM。由于两组之间的异质性, 我们使用倾向性评分将患者按年龄、性别和糖尿病病程进行配对。患者数据在各自记录在案的第一个治疗年度汇总。
结果
匹配队列为24164例, 其中T1 DM 29例, T2 DM 24000例, MI‐DM 120例, CPI‐DM 15例。CPI‐DM患者发病年龄中位数为63.6岁(57.2~72.8岁)(男性53.3%)。CPI‐DM组体重指数(26.823.9~28.1kg/m2)明显低于T2 DM组(29.826.2~34.3kg/m2, P=0.02)。CPI‐DM组糖化血红蛋白(HbA1c)明显高于MI‐DM组, 但随访时差异无统计学意义(P>0.05)。在6例CPI‐DM患者中发现糖尿病酮症酸中毒(DKA), 其中T1 DM:0%, T2 DM:0.4%, MI‐DM:0.0%。14名CPI‐DM患者接受胰岛素治疗, 3名患者接受额外的口服抗糖尿病药物治疗。T2 DM患者最常见的治疗方法是生活方式改变(38.8%), MI‐DM患者最常见的治疗方法是胰岛素(52.5%)。4例CPI‐DM患者合并自身免疫性甲状腺疾病(T1 DM:0.0%, T2 DM:1.0%, MIDM:0.8%)。
结论
这项对照研究的数据显示, CPI‐DM的特点是DKA患病率高、自身免疫性疾病以及代谢紊乱。对于接受CPI治疗的患者, 有必要进行结构化的诊断监测, 以预防DKA和其他急性内分泌并发症。
Highlights
This prospective study compares 15 patients with immune‐checkpoint induced diabetes mellitus (CPI‐DM) with a propensity score matched cohort of patients with other diabetes types. Diabetic ketoacidosis at onset and autoimmune comorbidity is more frequent in CPI‐DM patients. This can be avoided by regular glucose measurements and education on hyperglycemia.
Introduction
Bariatric surgery is a well-established treatment option for serious obesity and concomitant type 2 diabetes mellitus (T2DM). In this analysis, we investigated predictors for bariatric ...surgery in everyday clinical practice.
Materials and Methods
In the DPV-registry, patients with T2DM from Germany and Austria treated by bariatric surgery were compared to non-surgery controls by descriptive statistics and regression analysis.
Results
Among 277,862 patients with T2DM, 0.07% underwent bariatric surgery. Surgery patients were predominantly female 61.20%, younger median age (Q1;Q3) 54.74(47.40;61.61) vs. 70.04 (60.36;77.58) years and had a longer diabetes duration 11.21 (7.15;17.93) vs. 8.36 (2.94;14.91) years. They had a higher BMI 40.02 vs. 30.61 kg/m
2
, adjusted
p
< 0.0001 and a slightly lower HbA1c 7.25 vs. 7.56%, adjusted
p
< 0.05. There was a trend using more often insulin therapy (52.79 vs.50.08%, n.s.) with no difference in insulin dose/kg × day 0.56 vs. 0.58, n.s.. Sleeve gastrectomy was performed most frequently, followed by Roux-en-Y gastric bypass, gastric banding, gastric balloon and others. A 2-year follow-up data in 29 patients demonstrated significant reductions in BMI 45.23 to 38.00 kg/m
2
,
p
< 0.005 and HbA1c 7.98 to 6.98%,
p
< 0.005, and a trend for reduced insulin requirements 62.07 vs. 44.83%, n.s..
Conclusion
Despite favourable 2-year outcomes, bariatric surgery is still used rarely in patients with T2DM and obesity. BMI rather than metabolic control seems to represent the major selector for or against bariatric surgery in T2DM.
•Fracture risk among adults with T2D is associated with low HbA1c.•SGLT2-use, especially in women, is related to bone fractures in T2D.•The relation of BMI to fracture risk varies between fracture ...sites.
PDF
