Individuals with Peripheral Artery Disease (PAD) and Type 1 Diabetes Are More Likely to Undergo Limb Amputation than Those with PAD and Type 2 Diabetes
Background: Limited data exist comparing how type 1 diabetes mellitus (DM) and type 2 DM may have differential effects on peripheral artery disease (PAD) severity. We aimed to study the association of type of DM with the procedure utilized in hospitalizations with a diagnosis of PAD. Methods: We use...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-08-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/9/2809 |
| _version_ | 1797555062323544064 |
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| author | Nidhi Jain Manyoo A. Agarwal Diana Jalal Ayotunde O. Dokun |
| author_facet | Nidhi Jain Manyoo A. Agarwal Diana Jalal Ayotunde O. Dokun |
| author_sort | Nidhi Jain |
| collection | DOAJ |
| description | Background: Limited data exist comparing how type 1 diabetes mellitus (DM) and type 2 DM may have differential effects on peripheral artery disease (PAD) severity. We aimed to study the association of type of DM with the procedure utilized in hospitalizations with a diagnosis of PAD. Methods: We used the national inpatient sample databases from 2003 to 2014 to identify hospitalizations with a diagnosis of PAD and type 1 or type 2 DM. Logistic regression was utilized to evaluate the association between type of DM and procedure utilized (amputation-overall, major, endovascular revascularization, surgical revascularization). Results: We identified 14,012,860 hospitalizations with PAD diagnosis and DM, 5.6% (<i>n</i> = 784,720) had type 1 DM. The patients with type 1 DM were more likely to present with chronic limb-threatening ischemia (CLTI) (45.2% vs. 32.0%), ulcer (25.9% vs. 17.7%), or complicated ulcer (16.6% vs. 10.5%) (all <i>p</i> < 0.001) when compared to those with type 2 DM. Type 1 DM was independently and significantly associated with more amputation procedures (adjusted odds ratio = 1.12, 95% confidence interval [CI] I 1.08 to 1.16, <i>p</i> < 0.001). Overall, in-hospital mortality did not differ between the individuals with type 1 and type 2 DM. The overall mean (95% CI) length of stay (in days) was 6.6 (6.5 to 6.6) and was significantly higher for type 1 DM (7.8 [7.7 to 8.0]) when compared to those with type 2 DM (6.5 [6.4 to 6.6]). Conclusion: We observed that individuals with PAD and type 1 DM were more likely to present with CLTI and ulcer and undergo amputation when compared to those with PAD and type 2 diabetes. Further studies are needed to better understand the underlying mechanisms behind these findings and to identify novel interventions to reduce the risk of amputation in patients with type 1 DM. |
| first_indexed | 2024-03-10T16:42:07Z |
| format | Article |
| id | doaj.art-955a7047a1394032a516ea5faee94849 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T16:42:07Z |
| publishDate | 2020-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-955a7047a1394032a516ea5faee948492023-11-20T11:57:57ZengMDPI AGJournal of Clinical Medicine2077-03832020-08-0199280910.3390/jcm9092809Individuals with Peripheral Artery Disease (PAD) and Type 1 Diabetes Are More Likely to Undergo Limb Amputation than Those with PAD and Type 2 DiabetesNidhi Jain0Manyoo A. Agarwal1Diana Jalal2Ayotunde O. Dokun3Torrance Memorial Physician Network, Torrance, CA 90505, USADepartment of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USADivision of Nephrology, Department of Medicine, Carver College of Medicine, University of Iowa, Iowa, IA 52242, USADivision of Endocrinology and Metabolism, Department of Medicine, Carver College of Medicine, University of Iowa, Iowa, IA 52242, USABackground: Limited data exist comparing how type 1 diabetes mellitus (DM) and type 2 DM may have differential effects on peripheral artery disease (PAD) severity. We aimed to study the association of type of DM with the procedure utilized in hospitalizations with a diagnosis of PAD. Methods: We used the national inpatient sample databases from 2003 to 2014 to identify hospitalizations with a diagnosis of PAD and type 1 or type 2 DM. Logistic regression was utilized to evaluate the association between type of DM and procedure utilized (amputation-overall, major, endovascular revascularization, surgical revascularization). Results: We identified 14,012,860 hospitalizations with PAD diagnosis and DM, 5.6% (<i>n</i> = 784,720) had type 1 DM. The patients with type 1 DM were more likely to present with chronic limb-threatening ischemia (CLTI) (45.2% vs. 32.0%), ulcer (25.9% vs. 17.7%), or complicated ulcer (16.6% vs. 10.5%) (all <i>p</i> < 0.001) when compared to those with type 2 DM. Type 1 DM was independently and significantly associated with more amputation procedures (adjusted odds ratio = 1.12, 95% confidence interval [CI] I 1.08 to 1.16, <i>p</i> < 0.001). Overall, in-hospital mortality did not differ between the individuals with type 1 and type 2 DM. The overall mean (95% CI) length of stay (in days) was 6.6 (6.5 to 6.6) and was significantly higher for type 1 DM (7.8 [7.7 to 8.0]) when compared to those with type 2 DM (6.5 [6.4 to 6.6]). Conclusion: We observed that individuals with PAD and type 1 DM were more likely to present with CLTI and ulcer and undergo amputation when compared to those with PAD and type 2 diabetes. Further studies are needed to better understand the underlying mechanisms behind these findings and to identify novel interventions to reduce the risk of amputation in patients with type 1 DM.https://www.mdpi.com/2077-0383/9/9/2809amputationtype 1 diabetesperipheral artery diseaseNISHCUPtype 2 diabetes |
| spellingShingle | Nidhi Jain Manyoo A. Agarwal Diana Jalal Ayotunde O. Dokun Individuals with Peripheral Artery Disease (PAD) and Type 1 Diabetes Are More Likely to Undergo Limb Amputation than Those with PAD and Type 2 Diabetes Journal of Clinical Medicine amputation type 1 diabetes peripheral artery disease NIS HCUP type 2 diabetes |
| title | Individuals with Peripheral Artery Disease (PAD) and Type 1 Diabetes Are More Likely to Undergo Limb Amputation than Those with PAD and Type 2 Diabetes |
| title_full | Individuals with Peripheral Artery Disease (PAD) and Type 1 Diabetes Are More Likely to Undergo Limb Amputation than Those with PAD and Type 2 Diabetes |
| title_fullStr | Individuals with Peripheral Artery Disease (PAD) and Type 1 Diabetes Are More Likely to Undergo Limb Amputation than Those with PAD and Type 2 Diabetes |
| title_full_unstemmed | Individuals with Peripheral Artery Disease (PAD) and Type 1 Diabetes Are More Likely to Undergo Limb Amputation than Those with PAD and Type 2 Diabetes |
| title_short | Individuals with Peripheral Artery Disease (PAD) and Type 1 Diabetes Are More Likely to Undergo Limb Amputation than Those with PAD and Type 2 Diabetes |
| title_sort | individuals with peripheral artery disease pad and type 1 diabetes are more likely to undergo limb amputation than those with pad and type 2 diabetes |
| topic | amputation type 1 diabetes peripheral artery disease NIS HCUP type 2 diabetes |
| url | https://www.mdpi.com/2077-0383/9/9/2809 |
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