{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:47:03Z","timestamp":1792036023321,"version":"4.4.0"},"reference-count":16,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To compare lower extremity amputation (LEA) risk in adults with Type 2 diabetes and diabetic foot ulcer (DFU) treated with glucagon\u2010like peptide\u20101 receptor agonists (GLP\u20101 RAs) versus other glucose\u2010lowering therapy, and to test whether coded peripheral arterial disease (PAD) modifies this association and replicates across comparator classes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This new\u2010user, active\u2010comparator retrospective cohort study used the TriNetX Global Collaborative Network (queried 11 July 2026). Adults with Type 2 diabetes and DFU were propensity\u2010score matched 1:1 on 22 covariates, giving 21\u2009325 pairs for the primary comparison. Effect modification by coded PAD (ICD\u201010 I70.2) was examined in independently matched subgroups. Six sensitivity analyses were pre\u2010specified: 30\u2010 and 180\u2010day landmarks, all\u2010cause mortality, background\u2010therapy balancing, limb\u2010severity adjustment and a broadened PAD definition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      GLP\u20101 RA use was associated with lower 5\u2010year LEA risk than all non\u2010GLP\u20101 RA therapy (hazard ratio [HR]: 0.60, 95% CI: 0.54\u20130.67). The association was confined to the no\u2010PAD stratum (HR: 0.21, 0.13\u20130.33) and absent where PAD was coded (HR: 0.97, 0.78\u20131.20); ratio of hazard ratios 0.21 (0.13\u20130.36;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). All\u2010cause mortality was also lower (HR: 0.48, 0.45\u20130.50). The insulin no\u2010PAD estimate persisted under background\u2010therapy balancing (0.14), limb\u2010severity adjustment (0.16) and 30\u2010 and 180\u2010day landmarks (0.28, 0.33). Broadening the PAD definition attenuated the no\u2010PAD association without abolishing it (HR: 0.34, 0.17\u20130.65).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In Type 2 diabetes with DFU, GLP\u20101 RA use was associated with lower LEA risk, surviving six pre\u2010specified sensitivity analyses. These observational findings are hypothesis\u2010generating and require prospective confirmation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.71405","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:14:48Z","timestamp":1792034088000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>GLP<\/scp>\n                    \u20101 Receptor Agonist Therapy Is Associated With Lower Risk of Lower Extremity Amputation in Adults With Type 2 Diabetes and Foot Ulcer Without Coded Peripheral Arterial Disease: A Hypothesis\u2010Generating Real\u2010World Cohort Study"],"prefix":"10.1111","author":[{"given":"Hani","family":"Robinson","sequence":"first","affiliation":[{"name":"Department of Dermatology Hadassah Medical Center  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Yassin","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Hasharon Hospital, Rabin Medical Center  Petah Tikva Israel"},{"name":"Gray Faculty of Medical and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2517-4069","authenticated-orcid":false,"given":"Dror","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Hasharon Hospital, Rabin Medical Center  Petah Tikva Israel"},{"name":"Gray Faculty of Medical and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0029-422X","authenticated-orcid":false,"given":"Mohamad","family":"Eisa","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Hasharon Hospital, Rabin Medical Center  Petah Tikva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1262-7700","authenticated-orcid":false,"given":"Waseem Abu","family":"Rashed","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Hasharon Hospital, Rabin Medical Center  Petah Tikva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8182-8293","authenticated-orcid":false,"given":"Feras","family":"Qawasmi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Hasharon Hospital, Rabin Medical Center  Petah Tikva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assil","family":"Mahamid","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Hasharon Hospital, Rabin Medical Center  Petah Tikva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza","family":"Murad","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Hasharon Hospital, Rabin Medical Center  Petah Tikva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Khatib","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Hasharon Hospital, Rabin Medical Center  Petah Tikva 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