Diuretics Use and Risk of Amputation in Insulin-treated T2D Patients

Sarfaroj Khan 


October 29, 2020


  • Diuretic use was associated with an increased risk of lower extremity amputation (LEA) in insulin-treated patients with type 2 diabetes (T2D).

  • However, the association between LEA and diuretic use was marginally significant after adjustment and matching for a range of health and socio-economic-related factors.

Why this matters

  • Findings suggest that diuretics may play a role in mediating an increased risk of LEA in selected patients with comorbidities and indirectly implicate the potential mechanism of greater LEA risk with sodium-glucose cotransporter-2 inhibitors.

  • Patient selection is crucial when determining the use of therapies which induces volume depletion in high-risk patients with T2D.

Study design

  • This retrospective study included 10,320 insulin-treated patients with T2D (age, ≥18 years; diuretic users, n=5863; and non-diuretic users, n=4457) using data from The Health Improvement Network (THIN) database, UK.

  • Amputation risk was compared between a propensity score-matched cohort of diuretics users (n=290) vs non-users (n=290) over a 20-year period.

  • Funding: None.

Key results

  • Of 10,320 patients, 6454 (58.1%) were on diuretics.

  • In the full cohort, the risk of LEA was significantly higher in diuretics users vs non-diuretics users (HR, 1.89; 95% CI, 1.34-2.68; P<.001).

  • After adjustments for potential confounder, patients using diuretics vs non-diuretics were at a 2.45-fold higher risk of LEA (adjusted HR [aHR], 2.45; 95% CI, 1.63-3.69; P<.001).

  • In the matched cohort, this association was marginally significant after adjusting for potential confounders (aHR, 3.33; 95% CI, 1.17-18.9; P=.029).


  • Retrospective design.


Alshnbari A, Alkharaiji M, Anyanwagu U, Idris I. Diuretics and Risk of Lower Extremity Amputation Amongst Patients with Insulin-treated Type 2 Diabetes - Exploring the mechanism of possible Sodium Glucose co-transporter 2 inhibitor induced risk of lower extremity amputations. Curr Med Res Opin. 2020 Oct 21 [Epub ahead of print]. doi: 10.1080/03007995.2020.1840340. PMID: 33085525 View abstract

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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