Diurnal Temperature Ranges in Relation to Lower Limb Amputation Rate of Diabetic Foot in South Korea: A Population Based Nationwide Study

• Main Authors: Sung Hun Won, Hyung-Jin Chung, Jinyoung Lee, Ye Jin Jeon, Dong-Il Chun, Tae-Hong Min, Jaeho Cho, Sungho Won, Young Yi
• Format: Article
• Language: English
• Published: MDPI AG 2021-08-01
• Series: International Journal of Environmental Research and Public Health
• Subjects: diabetic foot; diabetic peripheral neuritis; diurnal temperature range; amputation
• Online Access: https://www.mdpi.com/1660-4601/18/17/9191

The evidence for the association between diurnal temperature range (DTR) and diabetic foot amputations is limited. We aimed to investigate the region-specific association between DTR and the amputation rate of diabetic foot in Korean national-wide data. Daily data on DTR and the rate of diabetic foot amputations from 16 provincial capital cities in Korea were obtained (2011–2018). In this study, the latitude ranged from 33°11′ N to 38°61′ N, and we classified each region according to latitude. Region 1, which was located at a relatively high latitude, included Seoul, Incheon, Gyeonggi-do, and Gangwon-do. Region 2, which was located at a relatively low latitude, included Busan, Ulsan, Gyeonsannam-do, Gwangju, Jeollanam-do, Jeollabuk-do, and Jeju-do. The region-specific DTR effects on the amputation rate were estimated based on a quasi-Poisson generalized linear model, combined with a distributed lag non-linear model based on the self-controlled case series design. The DTR impacts were generally limited to a period of nine days, while significant effects during lag days 7–14 were only found in the cities of Seoul, Incheon, and Gyeonggi-do (10th lag day: RR [95% CI]; Seoul: 1.015, [1.001–1.029]; Incheon: 1.052 [1.006–1.101]; Gyeonggi-do: 1.018 [1.002–1.034]). In the subgroup analysis (according to the latitude), an increase of 1 °C in DTR was associated with the risk of diabetic foot in relatively high latitude regions. DTR has considerable effects on the risk of diabetic foot amputation in various provinces in Korea, and it was particularly affected by latitude. The results can inform the decisions on developing programs to protect vulnerable subpopulations from adverse impacts.