Association Among Current Smoking, Alcohol Consumption, Regular Exercise, and Lower Extremity Amputation in Patients with Diabetic Foot: Nationwide Population-Based Study

Overview

Journal Endocrinol Metab (Seoul)

Specialty Endocrinology

Date 2022 Oct 12

PMID 36222086

Authors

Yoon Jae Lee

Kyung-Do Han

Jun Hyeok Kim

Affiliations

Soon will be listed here.

Abstract

Backgruound: The present study investigates whether modifiable behavioral factors of current cigarette smoking, heavy alcohol consumption, and regular exercise are associated with risk of lower extremity amputation (LEA) in diabetic patients.

Methods: A total of 2,644,440 diabetic patients (aged ≥20 years) was analyzed using the database of the Korean National Health Insurance Service. Cox proportional hazard regression was used to assess adjusted hazard ratios (HRs) for the behavioral factors with risk of LEA under adjustment for potential confounders.

Results: The risk of LEA was significantly increased by current cigarette smoking and heavy alcohol consumption (HR, 1.436; 95% confidence interval [CI], 1.367 to 1.508 and HR, 1.082; 95% CI, 1.011 to 1.158) but significantly decreased with regular exercise (HR, 0.745; 95% CI, 0.706 to 0.786) after adjusting for age, sex, smoking, alcohol consumption, exercise, low income, hypertension, dyslipidemia, body mass index, using insulin or oral antidiabetic drugs, and diabetic duration. A synergistically increased risk of LEA was observed with larger number of risky behaviors.

Conclusion: Modification of behaviors of current smoking, heavy alcohol intake, and exercise prevents LEA and can improve physical, emotional, and social quality of life in diabetic patients.

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References

Tennvall G, Apelqvist J . Health-related quality of life in patients with diabetes mellitus and foot ulcers. J Diabetes Complications. 2000; 14(5):235-41. DOI: 10.1016/s1056-8727(00)00133-1. View

Lee J, Lee J, Park S, Shin S, Kim K . Cohort Profile: The National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea. Int J Epidemiol. 2016; 46(2):e15. DOI: 10.1093/ije/dyv319. View

Reiber G . The epidemiology of diabetic foot problems. Diabet Med. 1996; 13 Suppl 1:S6-11. View

Armstrong D, Boulton A, Bus S . Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017; 376(24):2367-2375. DOI: 10.1056/NEJMra1615439. View

Bus S, van Deursen R, Armstrong D, Lewis J, Caravaggi C, Cavanagh P . Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review. Diabetes Metab Res Rev. 2015; 32 Suppl 1:99-118. DOI: 10.1002/dmrr.2702. View

Lavery L, Armstrong D, Wunderlich R, Tredwell J, Boulton A . Diabetic foot syndrome: evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes disease management cohort. Diabetes Care. 2003; 26(5):1435-8. DOI: 10.2337/diacare.26.5.1435. View

Papanas N, Maltezos E . Glycated Hemoglobin as a Risk Factor for Lower Extremity Amputations in Diabetes: "Success Is Counted Sweetest". Int J Low Extrem Wounds. 2015; 14(2):106-7. DOI: 10.1177/1534734615592313. View

Gulliford M, Mahabir D . Diabetic foot disease and foot care in a Caribbean community. Diabetes Res Clin Pract. 2002; 56(1):35-40. DOI: 10.1016/s0168-8227(01)00343-6. View

Neto A, Zantut-Wittmann D, Fernandes T, Nery M, Parisi M . Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients. Endocrine. 2012; 44(1):119-24. DOI: 10.1007/s12020-012-9829-2. View

10.

Ben G, Gnudi L, Maran A, Gigante A, Duner E, Iori E . Effects of chronic alcohol intake on carbohydrate and lipid metabolism in subjects with type II (non-insulin-dependent) diabetes. Am J Med. 1991; 90(1):70-6. DOI: 10.1016/0002-9343(91)90508-u. View

11.

Adler A, Boyko E, Ahroni J, Smith D . Lower-extremity amputation in diabetes. The independent effects of peripheral vascular disease, sensory neuropathy, and foot ulcers. Diabetes Care. 1999; 22(7):1029-35. DOI: 10.2337/diacare.22.7.1029. View

12.

Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y . Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis . Ann Med. 2016; 49(2):106-116. DOI: 10.1080/07853890.2016.1231932. View

13.

Lakier J . Smoking and cardiovascular disease. Am J Med. 1992; 93(1A):8S-12S. DOI: 10.1016/0002-9343(92)90620-q. View

14.

Pham H, Armstrong D, Harvey C, Harkless L, Giurini J, Veves A . Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. Diabetes Care. 2000; 23(5):606-11. DOI: 10.2337/diacare.23.5.606. View

15.

Ahn S, Song R . Effects of Tai Chi Exercise on glucose control, neuropathy scores, balance, and quality of life in patients with type 2 diabetes and neuropathy. J Altern Complement Med. 2012; 18(12):1172-8. PMC: 3513979. DOI: 10.1089/acm.2011.0690. View

16.

Jeffcoate W, Price P, Phillips C, Game F, Mudge E, Davies S . Randomised controlled trial of the use of three dressing preparations in the management of chronic ulceration of the foot in diabetes. Health Technol Assess. 2009; 13(54):1-86, iii-iv. DOI: 10.3310/hta13540. View

17.

Ang L, Jaiswal M, Martin C, Pop-Busui R . Glucose control and diabetic neuropathy: lessons from recent large clinical trials. Curr Diab Rep. 2014; 14(9):528. PMC: 5084623. DOI: 10.1007/s11892-014-0528-7. View

18.

Apelqvist J, Larsson J, Agardh C . Long-term prognosis for diabetic patients with foot ulcers. J Intern Med. 1993; 233(6):485-91. DOI: 10.1111/j.1365-2796.1993.tb01003.x. View

19.

Apelqvist J, Ragnarson-Tennvall G, Persson U, Larsson J . Diabetic foot ulcers in a multidisciplinary setting. An economic analysis of primary healing and healing with amputation. J Intern Med. 1994; 235(5):463-71. DOI: 10.1111/j.1365-2796.1994.tb01104.x. View

20.

Armstrong D, Lavery L, Harkless L . Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care. 1998; 21(5):855-9. DOI: 10.2337/diacare.21.5.855. View