Increase in diabetic ulcers, but no increase in amputations

NewsBot · Dec 26, 2008

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Four-fold increase in foot ulcers in type 2 diabetic subjects without an increase in major amputations by a multidisciplinary setting.
Hedetoft C, Rasmussenpodiatrist A, Fabrin J, Kølendorf K.
Diabetes Res Clin Pract. 2008 Dec 22. [Epub ahead of print]

AIMS: We observed a large increase in type 2 diabetic subjects with foot ulcers in our diabetic outpatient foot clinic and wanted to identify the amputations rate and individuals at risk of amputations by comparing those who had had a regular control in the multidisciplinary foot clinic prior to the amputations and those who had not.

METHODS: We examined all clinical records from the orthopaedic surgery department and the diabetic outpatient foot clinic of diabetic patients who underwent amputations for 6 years.

RESULTS: Eighty-eight patients with type 2 diabetes underwent 142 amputations; 42 major and 100 minor amputations. There was no increase in the number of major amputations in this period. In the group not followed in the foot clinic prior to amputations we showed a greater major amputations rate (p<0.05), although this group had a shorter duration of diabetes and less retinopathy, nephropathy and AMI/stroke. Everyone in both groups had severe neuropathy and ischemia.

CONCLUSION: A multidisciplinary diabetic foot clinic may decrease the risk of major amputations in type 2 diabetic subjects with foot ulcers. Severe neuropathy and ischemia were the most important risk factors.
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NewsBot · Jul 30, 2009

Decreasing amputation rates in patients with diabetes—a population-based study

C. J. Schofield, N. Yu, A. S. Jain and G. P. Leese
Diabetic Medicine Volume 26 Issue 8, Pages 773 - 777

Aims To assess the changing rate of amputation in patients with diabetes over a 7-year period.

Methods All patients undergoing lower extremity amputation in Tayside, Scotland between 1 January 2000 and 31 December 2006 were identified. Temporal linkage of cases to the diabetes database was used to ascertain which amputations were in patients with diabetes.

Results The incidence of major amputations fell from 5.1 [95% confidence interval (CI) 3.8–6.4] to 2.9 (95% CI 1.9–3.8) per 1000 patients with diabetes (P < 0.05). There is a clear linear trend in the adjusted incidence of major amputation (P = 0.023 and 0.027 for age- and sex-adjusted, and duration- and sex-adjusted incidences, respectively). The adjusted incidence of total amputations followed decreased linear regression trend over the whole study period when adjusted for age and sex or diabetes duration and sex (P = 0.002).

Conclusions There has been a significant reduction in the incidence of major lower extremity amputation in patients with diabetes over the 7-year period.
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NewsBot · Sep 19, 2011

Lower extremity amputations — a review of global variability in incidence
P. W. Moxey, et al
Diabet. Med. 28, 1144–1153 (2011)

Aim To quantify global variation in the incidence of lower extremity amputations in light of the rising prevalence of diabetes mellitus.

Methods An electronic search was performed using the EMBASE and MEDLINE databases from 1989 until 2010 for incidence of lower extremity amputation. The literature review conformed to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards.

Results Incidence of all forms of lower extremity amputation ranges from 46.1 to 9600 per 105 in the population with diabetes compared with 5.8–31 per 105 in the total population. Major amputation ranges from 5.6 to 600 per 105 in the population with diabetes and from 3.6 to 68.4 per 105 in the total population. Significant reductions in incidence of lower extremity amputation have been shown in specific at-risk populations after the introduction of specialist diabetic foot clinics.

Conclusion Significant global variation exists in the incidence of lower extremity amputation. Ethnicity and social deprivation play a significant role but it is the role of diabetes and its complications that is most profound. Lower extremity amputation reporting methods demonstrate significant variation with no single standard upon which to benchmark care. Effective standardized reporting methods of major, minor and at-risk populations are needed in order to quantify and monitor the growing multidisciplinary team effect on lower extremity amputation rates globally.
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