Register study explores gout's impact on lower-limb amputations in Type 2 diabetes, suggesting significant implications.
Introduction and Objective: Clinical observations over years designate, that the co-existence of gout and a diabetic foot ulcer may prolong healing, leading to a lower-limb amputation. This association remains unclear. Our objective was to describe a possible contribution of gout toward lower limb amputations and amputation levels in persons with Type 2 diabetes Methods: Based on Statistics Denmark, our unique central governmental high-quality data authority, we investigated 601,541 persons with Type 2 diabetes in detail. A total of 4,912 persons with lower-limb amputations were found and 39,101 controls were identified. We used ATC codes to detect urate-lowering drug use and IDC-10 for diagnosis. Application of conditional logistic regressions delivered associations, all adjusted for diabetes duration, diabetes complications, acute myocardial infarction and peripheral artery disease. Results: Basic analysis showed gout to be associated with increased risk of lower-limb amputations in Type 2 diabetes (OR=1.85, 95% CI: 1.69-2.02). Significant also after full adjustments (OR=1.53, 95% CI: 1.37-1.69). Furthermore, higher risks for lower-limb amputations were found at increasingly more distal anatomical levels. Toe amputations at OR=1.65 (95% CI: 1.32-2.05) compared to above-knee amputations OR=1.37 (95% CI: 1.12-1.68). Conclusion: Our study showed gout to be an independent contributor to lower-limb amputations, with an odds ratio of more than 50% after adjustment. Amputations were increased at all anatomical levels, but significantly stronger so, at more distal levels. Our results unveil a significant and unexplained impact of gout on the frequency of amputations in persons with Type 2 diabetes. Disclosure J. Røikjer: Other - Paid Lecturer; Ended; Novo Nordisk A/S, Boehringer Ingelheim International GmbH. A.V. Kvist: Stock/Shareholder; Current; Novo Nordisk A/S.
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