糖尿病足潰瘍、血管問題 可預測死亡


  【24drs.com】研究者於紐奧良舉辦的美國糖尿病協會第76屆科學會議中報告指出,下肢血管併發症與足部潰瘍可顯著預測糖尿病患的死亡率。
  
  發表此篇研究的西雅圖華盛頓大學Edward Boyko醫師表示,糖尿病增加了週邊動脈疾病、神經病變和足部潰瘍的風險,這些併發症都與死亡率增加有關。但是,這些下肢併發症和死亡率之間是否有獨立關聯則未知,也不知道它們是否可預測長期死亡。
  
  Boyko醫師解釋,我們的目標是要進行這個研究,採用退伍軍人全國健康照護資料,在研究門診中,前瞻追蹤1,456名糖尿病男性退伍軍人。他的團隊使用多變項Cox回歸模式估計死亡率之風險比,在追蹤的13,038人-年中,發生1,103例死亡。
  
  在開始時與追蹤期,評估研究對象的糖尿病特徵、HbA1c、生活型態、視力、足部特徵、足部單股尼龍纖維敏感度、44°時的足背經皮血氧飽和度、曾發生與突發的足部潰瘍及截肢、踝肱指數、估計腎絲球過濾速率、血清白蛋白值。多變項分析中,死亡率與截肢、神經病變、跛行無關。
  
  會議主席、華盛頓特區喬治城大學醫院的Paul Kim醫師表示,這些患者不會死於截肢,心臟疾患比較可能引起死亡。
  
  Kim醫師強調,醫師能越早確認高風險患者越好。
  
  下肢問題相當常見,重點在於,我們在這些問題加劇、複雜化與快速惡化之前就確定它們。
  
  資料來源:http://www.24drs.com/
  
  Native link:Diabetic Foot Ulcers, Vascular Problems Predict Death

Diabetic Foot Ulcers, Vascular Problems Predict Death

By Allison Shelley
Medscape Medical News

Lower limb vascular complications and foot ulcers significantly predict mortality in patients with diabetes, researchers reported at the American Diabetes Association 76th Scientific Sessions in New Orleans.

Diabetes increases the risk for peripheral arterial disease, neuropathy, and foot ulcer, and all of these complications have been associated with an increase in mortality, said presenter Edward Boyko, MD, from the University of Washington in Seattle. But whether there is an independent association between these lower limb complications and mortality is not known, nor is whether they predict death in the long term.

His team used multivariable Cox regression models to estimate hazard ratios for mortality. During 13,038 person-years of follow-up, 1103 deaths occurred.

At baseline and follow-up, study participants were assessed for features of diabetes, HbA1c, lifestyle, vision, foot characteristics, foot monofilament insensitivity, dorsal foot transcutaneous oximetry at 44°, previous and incident foot ulcer and amputation, ankle-brachial index, estimated glomerular filtration rate, and serum albumin level.

On multivariable analysis, mortality was not associated with amputation, neuropathy, or claudication, as previously reported by Medscape Medical News.

"These patients won't die from an amputation," said session chair Paul Kim, MD, from Georgetown University Hospital in Washington, DC.

"It's heart disease that will be the more likely cause of death," he told Medscape Medical News.

The earlier physicians identify high-risk patients, the better, Dr Kim stressed.

"Lower limb problems are very common. It's important that we identify them early before these cases escalate and get very complicated, very quickly."

Dr Boyko and Dr Kim have disclosed no relevant financial relationships.

American Diabetes Association (ADA) 76th Scientific Sessions:Presented June 11, 2016.

    
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