Please use this identifier to cite or link to this item: https://doi.org/10.1007/s00125-021-05441-3
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dc.titleDiabetes-related lower extremity complications in a multi-ethnic Asian population: a 10 year observational study in Singapore
dc.contributor.authorTESSA RIANDINI
dc.contributor.authorPang, Deanette
dc.contributor.authorToh, Matthias PHS
dc.contributor.authorTan, Chuen Seng
dc.contributor.authorLiu, Daveon YK
dc.contributor.authorChoong, Andrew MTL
dc.contributor.authorCHANDRASEKAR SADHANA
dc.contributor.authorTAI E SHYONG
dc.contributor.authorTan, Kelvin B
dc.contributor.authorKavita Venkataraman
dc.date.accessioned2021-04-26T05:17:19Z
dc.date.available2021-04-26T05:17:19Z
dc.date.issued2021-04-25
dc.identifier.citationTESSA RIANDINI, Pang, Deanette, Toh, Matthias PHS, Tan, Chuen Seng, Liu, Daveon YK, Choong, Andrew MTL, CHANDRASEKAR SADHANA, TAI E SHYONG, Tan, Kelvin B, Kavita Venkataraman (2021-04-25). Diabetes-related lower extremity complications in a multi-ethnic Asian population: a 10 year observational study in Singapore. Diabetologia. ScholarBank@NUS Repository. https://doi.org/10.1007/s00125-021-05441-3
dc.identifier.issn0012-186X
dc.identifier.issn1432-0428
dc.identifier.urihttps://scholarbank.nus.edu.sg/handle/10635/190221
dc.description.abstractAims/hypothesis Diabetes progression and complication risk are different in Asian people compared with those of European ancestry. In this study, we sought to understand the epidemiology of diabetes-related lower extremity complications (DRLECs: symptomatic peripheral arterial disease, ulceration, infection, gangrene) and amputations in a multi-ethnic Asian population. Methods This was a retrospective observational study using data obtained from one of three integrated public healthcare clusters in Singapore. The population consisted of individuals with incident type 2 diabetes who were of Chinese, Malay, Indian or Other ethnicity. We examined incidence, time to event and risk factors of DRLECs and amputation. Results Between 2007 and 2017, of the 156,593 individuals with incident type 2 diabetes, 20,744 developed a DRLEC, of whom 1208 underwent amputation. Age- and sex-standardised incidence of first DRLEC and first amputation was 28.29/1000 personyears of diabetes and 8.18/1000 person-years of DRLEC, respectively. Incidence of both was highest in individuals of Malay ethnicity (DRLEC, 36.09/1000 person-years of diabetes; amputation, 12.96/1000 person-years of DRLEC). Median time from diabetes diagnosis in the public healthcare system to first DRLEC was 30.5 months for those without subsequent amputation and 10.9 months for those with subsequent amputation. Median time from DRLEC to first amputation was 2.3 months. Older age (p < 0.001), male sex (p < 0.001), Malay ethnicity (p < 0.001), Indian ethnicity (p = 0.014), chronic comorbidities (nephropathy [p < 0.001], heart disease [p < 0.001], stroke [p < 0.001], retinopathy [p < 0.001], neuropathy [p < 0.001]), poorer or missing HbA1c (p < 0.001), lower (p < 0.001) or missing (p = 0.002) eGFR, greater or missing BMI (p < 0.001), missing LDL-cholesterol (p < 0.001) at diagnosis, and ever-smoking (p < 0.001) were associated with higher hazard of DRLEC. Retinopathy (p < 0.001), peripheral vascular disease (p < 0.001), poorer HbA1c (p < 0.001), higher (p = 0.009) or missing (p < 0.001) LDL-cholesterol and missing BMI (p = 0.008) were associated with higher hazard of amputation in those with DRLEC. Indian ethnicity (p = 0.007) was associated with significantly lower hazard of amputation. Conclusions/interpretation This study has revealed important ethnic differences in risk of diabetes-related lower limb complications, with Malays most likely to progress to DRLEC. Greater research efforts are needed to understand the aetiopathological and sociocultural processes that contribute to the higher risk of lower extremity complications among these ethnic groups.
dc.publisherSpringer Science and Business Media LLC
dc.sourceElements
dc.subjectAmputation
dc.subjectDiabetes-related lower extremity complications
dc.subjectEpidemiology
dc.subjectIncidence rate
dc.subjectProgression
dc.subjectRisk factors
dc.typeArticle
dc.date.updated2021-04-26T05:15:00Z
dc.contributor.departmentMEDICINE
dc.contributor.departmentSURGERY
dc.contributor.departmentSAW SWEE HOCK SCHOOL OF PUBLIC HEALTH
dc.description.doi10.1007/s00125-021-05441-3
dc.description.sourcetitleDiabetologia
dc.published.statePublished
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