(DLS-031) Association Among Current Cigarette Smoking, Heavy Alcohol Consumption, Regular Exercise, and Risk of Lower Extremity Amputation in Patients with Diabetic Foot: A Nationwide Population-Based Study

Introduction: The present study investigates whether modifiable behavioral factors of current cigarette smoking, heavy alcohol consumption, and regular exercise are associated with risk of lower extremity amputation (LEA) in diabetic patients.

Methods: 2,644,440 diabetic patients (aged≥20 years) were analyzed by using the database of the Korean National Health Insurance Service. (Table 1) Cox proportional hazard regression was used to assess adjusted hazard ratios for the behavioral factors with the risk of LEA under adjustment for potential confounders.


Results: The risk of LEA was significantly increased by current cigarette smoking and heavy alcohol consumption (HR 1.436; 95% CI, 1.367-1.508; HR 1.082; 95% CI, 1.011-1.158) but significantly decreased with regular exercise (HR 0.745; 95% CI, 0.706-0.786) after adjusting for age, sex, smoking, alcohol consumption, exercise, low income, hypertension, dyslipidemia, body mass index, using insulin or oral antidiabetic drugs, and diabetic duration. A synergistically increased risk of LEA was observed with larger number of risky behaviors.

Discussion: Modification of behaviors of current smoking, heavy alcohol intake, and exercise prevents LEA and can improve physical, emotional, and social quality of life in diabetic patients.