Increased risk of type 2 diabetes after traumatic amputation: a nationwide retrospective cohort study

Background: Amputation confers disabilities upon patients and is linked to cardiometabolic morbidity and mortality. We aimed to compare the incidence of type 2 diabetes (T2DM) between individuals following amputation with those of the general population.

Methods: We performed a population-based retrospective cohort study using the Nationwide Health Insurance Service database. A total of 21,343 individuals with amputation during 2010-2018 and their 1:3 age- and sex-matched controls was included. We conducted Cox proportional hazard analysis to calculate the risk of T2DM among individuals with amputation.

Results: During the 4.2 ± 2.5 year mean follow-up period, there were 912 incident T2DM cases (10.7 per 1,000 person-years) among individuals with amputation. Individuals with amputation had a higher risk for T2DM (adjusted hazard ratio [aHR] 1.11, 95% confidence interval [CI] 1.03-1.20) compared with matched controls. The risks were increased further when accompanied with disability; those with severe disability had a higher risk of T2DM (aHR 1.77, 95% CI 1.20-2.60) than matched controls. Individuals with proximal upper limb amputation (aHR 1.10, 95% CI 1.02-1.18) and proximal lower limb amputation (aHR 3.60, 95% CI 1.50-8.64) had a higher risk of T2DM compared with matched controls.

Conclusions: Individuals with amputation were at significantly greater risk for T2DM than the general population, particularly those with severe disability and proximal amputation. Innovative strategies that improve and support the long-term T2DM risk for severely injured individuals with proximal amputation are warranted.