Medical strategies to reduce amputation in patients with Type 2 diabetes

Diabetic Medicine - Tập 30 Số 8 - Trang 893-900 - 2013
Rayaz A. Malik1, Solomon Tesfaye2, Dan Ziegler3
1Division of Cardiovascular Medicine University of Manchester Manchester
2Diabetes Research Unit Royal Hallamshire Hospital Sheffield Teaching Hospitals Sheffield UK
3Institute for Clinical Diabetology German Diabetes Center at the Heinrich‐Heine University Leibniz Center for Diabetes Research Department of Metabolic Diseases University, Hospital Düsseldorf Germany

Tóm tắt

AbstractLower extremity amputation is a common and disabling complication of Type 2 diabetes. Whilst the introduction of specialist multidisciplinary teams has led to a reduction in the incidence of lower extremity amputation in some centres, the overall prevalence of diabetes‐related amputation has actually increased in recent decades. The aetiology of diabetes‐related amputation is complex, with neuropathy, macrovascular and microvascular disease contributing significantly. Ulceration, previous amputation, increasing diabetes duration and poor long‐term control of glycaemia and lipids are important risk factors for amputation in populations with diabetes. Major randomized intervention trials of blood glucose‐lowering or anti‐hypertensive therapies in populations with diabetes have shown limited reductions in neuropathy and/or macrovascular disease, and no benefit on amputation rates. In contrast, a recent analysis from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study showed a significantly reduced rate of minor, but not major amputations in patients with Type 2 diabetes treated with fenofibrate. Mechanistic studies are clearly needed to understand the basis of this benefit.

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Tài liệu tham khảo

International Diabetes Federation, The Global Burden. Diabetes Atlas

10.1016/j.diabres.2007.01.005

10.1016/j.diabres.2009.11.016

10.1007/s00125-012-2468-6

10.1080/17453670810016696

10.2337/dc07-1178

10.1001/archinte.162.1.73

10.1111/j.1464-5491.1993.tb00057.x

10.1046/j.1464-5491.2002.00583.x

10.2337/diacare.28.8.1869

10.2337/dc09-2067

10.1056/NEJMoa032782

10.1111/j.1529-8027.2009.00237.x

10.1007/PL00002941

10.2337/dc06-0912

10.2337/dc10-0878

10.2337/diacare.18.4.509

10.1016/j.jvs.2010.06.100

10.2337/dc09-2007

10.1016/S1262-3636(07)70238-0

10.1136/bmj.321.7258.412

10.1136/bmj.317.7160.703

10.1016/j.mehy.2007.02.040

10.3109/17453678308996589

10.1177/1534734609334808

10.2337/dc12-s011

Dorresteijn JA, 2010, Patient education for preventing diabetic foot ulceration, Cochrane Database Syst Rev, 5, CD001488

10.1007/s00125-008-1110-0

10.1016/S0140-6736(05)67667-2

10.2337/dc08-1543

10.1016/S0140-6736(07)61607-9

10.1007/s00125-010-1951-1

10.1016/S0140-6736(09)60698-X

10.1016/S0140-6736(98)07019-6

10.1016/S0140-6736(98)07037-8

10.1056/NEJMoa0806470

10.1056/NEJMoa0806359

Heart Protection Study Collaborative Group (writing committee: Collins R, Armitage J, Parish S, Sleight P, Peto R), 2003, MRC/BHF Heart Protection Study of cholesterol‐lowering with simvastatin in 5963 people with diabetes: randomised placebo‐controlled trial, Lancet, 361, 2005, 10.1016/S0140-6736(03)13636-7

10.1056/NEJM200001203420301

10.1056/NEJM200001203420302

10.1016/j.ehj.2003.10.033

10.1016/S0140-6736(99)12323-7

10.1056/NEJMoa0802987

10.1016/S0140-6736(07)61303-8

10.1007/s00125-009-1457-x

10.1056/NEJMoa0802743

10.1016/S0140-6736(10)60576-4

10.1056/NEJMoa0808431

10.2337/db08-1771

10.1007/s00125-007-0919-2

10.1016/S0140-6736(08)60333-5

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Diabetic Medicine

Tập 30 Số 8

893-900

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