{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T09:37:11Z","timestamp":1789983431142,"version":"4.0.1"},"reference-count":27,"publisher":"BMJ","issue":"1","funder":[{"name":"Swedish Diabetes Foundation"},{"DOI":"10.13039\/501100007687","name":"Svenska L\u00e4kares\u00e4llskapet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007687","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Swedish heart and lung foundation"},{"name":"Novonordisk foundation"},{"name":"Swedish Government"},{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2019,1,29]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>This study investigates how the excess risk of lower extremity amputations (amputations) in people with type 1\u2009diabetes mellitus (DM) differs from the general population by diabetes duration, glycemic control, and renal complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research design and methods<\/jats:title>\n                  <jats:p>We analyzed data from people with type 1\u2009DM from the Swedish National Diabetes Register without prior amputation from January 1998 to December 2013. Each person (n=36\u2009872) was randomly matched with five controls by sex, age, and county (n=184\u2009360) from the population without diabetes. All were followed until first amputation, death or end of follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The overall adjusted HR for all amputation was 40.1 (95% CI 32.8 to 49.1) for type 1\u2009DM versus controls. HR increased with longer diabetes duration. The incidence of amputation\/1000 patient-years was 3.18 (95% CI 2.99 to 3.38) for type 1\u2009DM and 0.07 (95% CI 0.05 to 0.08) for controls. The incidence decreased from 1998\u20132001 (3.09, 95% CI 2.56 to 3.62) to 2011\u20132013 (2.64, 95% CI 2.31 to 2.98). The HR for major amputations was lower than for minor amputations and decreased over the time period (p=0.0045). Worsening in glycemic control among patients with diabetes led to increased risk for amputation with an HR of 1.80 (95% CI 1.72 to 1.88) per 10\u2009mmol\/mol (1%) increase in hemoglobin A1c.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Although the absolute risk of amputation is relatively low, the overall excess risk was 40 times that of controls. Excess risk was substantially lower for those with good glycemic control and without renal complications, but excess risk still existed and is greatest for minor amputations.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjdrc-2018-000602","type":"journal-article","created":{"date-parts":[[2019,4,15]],"date-time":"2019-04-15T08:05:15Z","timestamp":1555315515000},"page":"e000602","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Excess risk of lower extremity amputations in people with type 1 diabetes compared with the general population: amputations and type 1 diabetes"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2083-2512","authenticated-orcid":false,"given":"Arnd\u00eds Finna","family":"\u00d3lafsd\u00f3ttir","sequence":"first","affiliation":[{"name":"Department of Medicine, NU Hospital Group, Uddevalla, Sweden"},{"name":"Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann-Marie","family":"Svensson","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden"},{"name":"Centre of Registers in Region V\u00e4stra G\u00f6taland, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldina","family":"Pivodic","sequence":"additional","affiliation":[{"name":"Statistiska Konsultgruppen, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soffia","family":"Gudbj\u00f6rnsdottir","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden"},{"name":"Centre of Registers in Region V\u00e4stra G\u00f6taland, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Nystr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Wedel","sequence":"additional","affiliation":[{"name":"Department of Health Metrics, Health Metrics Sahlgrenska Academy, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Rosengren","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Lind","sequence":"additional","affiliation":[{"name":"Department of Medicine, NU Hospital Group, Uddevalla, Sweden"},{"name":"Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,4,14]]},"reference":[{"key":"2025073112004461000_7.1.e000602.1","unstructured":"Berne C , Agardh C-D . 2009 diabetes. 4 ed. 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