Decreasing incidence of major amputations in people with diabetes

Diabetologia. 2000 Jul;43(7):844-7. doi: 10.1007/s001250051459.

Abstract

Aims/hypothesis: To assess the results of the strategy used in avoiding major amputations in patients with diabetes mellitus.

Methods: A retrospective study for the years 1981 to 1995 in a central district hospital in Copenhagen with a catchment area population of about 178,000.

Results: There were 463 major leg amputations and the incidence decreased from 27.2 to 6.9/100,000 population (75%). The decrease in patients with Type I (insulin-dependent) diabetes mellitus was from 10.0 to 4.1 (59%) and in Type II (non-insulin-dependent) diabetes mellitus from 17.2 to 2.8/100,000 people (84%). Analysis showed that the diabetic population remained constant despite a considerable fall in the number of older people. During the study period infra-popliteal arterial bypass was introduced for the treatment of critical lower limb ischaemia and in diabetic patients the number of bypasses increased from zero to 13/100,000 population. The total number of revascularisation procedures in people with diabetes increased from 2.6 to 19.2/100,000 population. Moreover, a multidisciplinary diabetic foot clinic was established.

Conclusion/interpretation: A 75% reduction in the incidence of major amputations coincided with a sevenfold increase in revascularization procedures and the establishment of a multidisciplinary diabetic foot clinic suggesting these measures are important in the prevention of diabetic leg amputations.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Amputation / statistics & numerical data*
  • Denmark / epidemiology
  • Diabetes Mellitus, Type 1 / epidemiology*
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Diabetic Foot / epidemiology*
  • Diabetic Foot / surgery*
  • Female
  • Hospitals, District
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Retrospective Studies
  • Sex Factors