Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/126303
Citations | ||
Scopus | Web of Science® | Altmetric |
---|---|---|
?
|
?
|
Type: | Journal article |
Title: | Plasma total bilirubin levels predict amputation events in type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study |
Author: | Chan, K. O'Connell, R. Sullivan, D. Hoffmann, L. Rajamani, K. Whiting, M. Donoghoe, M. Vanhala, M. Hamer, A. Yu, B. Stocker, R. Ng, M. Keech, A. |
Citation: | Diabetologia, 2013; 56(4):724-736 |
Publisher: | Springer Nature |
Issue Date: | 2013 |
ISSN: | 0012-186X 1432-0428 |
Statement of Responsibility: | K.H. Chan, R.L. O’Connell, D.R. Sullivan, L.S. Hoffmann, K. Rajamani, M. Whiting, M.W. Donoghoe, M. Vanhala, A. Hamer, B. Yu, R. Stocker, M.K.C. Ng, A.C. Keech (on behalf of the FIELD study investigators) |
Abstract: | Aims/hypothesis: Bilirubin has antioxidant and anti-inflammatory activities. Previous studies demonstrated that higher bilirubin levels were associated with reduced prevalence of peripheral arterial disease (PAD). However, the relationship between bilirubin and lower-limb amputation, a consequence of PAD, is currently unknown. We hypothesised that, in patients with type 2 diabetes, bilirubin concentrations may inversely associate with lower-limb amputation. Methods: The relationship between baseline plasma total bilirubin levels and amputation events was analysed in 9,795 type 2 diabetic patients from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. The analysis plan was pre-specified. Lower-limb amputation was adjudicated blinded to treatment allocation. Relevant clinical and biochemical data were available for analyses. Amputation was a pre-specified tertiary endpoint. Results: Bilirubin concentrations were significantly inversely associated with lower-limb amputation, with a greater than threefold risk gradient across levels. Individuals with lower bilirubin concentrations had a higher risk for first amputation (HR 1.38 per 5 μmol/l decrease in bilirubin concentration, 95% CI 1.07, 1.79, p = 0.013). The same association persisted after adjustment for baseline variables, including age, height, smoking status, γ-glutamyltransferase level, HbA1c, trial treatment allocation (placebo vs fenofibrate), as well as previous PAD, non-PAD cardiovascular disease, amputation or diabetic skin ulcer, neuropathy, nephropathy and diabetic retinopathy (HR 1.38 per 5 μmol/l decrease in bilirubin concentration, 95% CI 1.05, 1.81, p = 0.019). Conclusions/interpretation: Our results identify a significant inverse relationship between bilirubin levels and total lower-limb amputation, driven by major amputation. Our data raise the hypothesis that bilirubin may protect against amputation in type 2 diabetes. |
Keywords: | Amputation; bilirubin; Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study; peripheral arterial disease; type 2 diabetes mellitus |
Rights: | © Springer-Verlag Berlin Heidelberg 2013 |
DOI: | 10.1007/s00125-012-2818-4 |
Grant ID: | NHMRC |
Published version: | http://dx.doi.org/10.1007/s00125-012-2818-4 |
Appears in Collections: | Aurora harvest 4 Medicine publications |
Files in This Item:
There are no files associated with this item.
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.