Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 31 (8), 1536-40

Risks of Nontraumatic Lower-Extremity Amputations in Patients With Type 1 Diabetes: A Population-Based Cohort Study in Sweden


Risks of Nontraumatic Lower-Extremity Amputations in Patients With Type 1 Diabetes: A Population-Based Cohort Study in Sweden

Junmei Miao Jonasson et al. Diabetes Care.


Objective: The purpose of this study was to estimate the risks of nontraumatic lower-extremity amputations (LEAs) in patients with type 1 diabetes.

Research design and methods: We identified 31,354 patients with type 1 diabetes (15,001 women and 16,353 men) in the Swedish Inpatient Register between 1975 and 2004. The incidence of nontraumatic LEAs was followed up until 31 December 2004 by cross-linkage in the Inpatient Register and linkage to the Death and Migration registers. Poisson regression modeling was used to compare the risks of nontraumatic LEAs during different calendar periods of follow-up, with adjustment for both sex and attained age at follow-up. Standardized incidence ratios (SIRs) were used to estimate the relative risks (RRs) with the age-, sex-, and calendar period-matched general Swedish population as reference. The cumulative probability of nontraumatic LEAs was calculated by the Kaplan-Meier method.

Results: In total, 465 patients with type 1 diabetes underwent nontraumatic LEAs. The risk was lower during the most recent calendar period (2000-2004) than during the period before 2000 (RR 0.6 [95% CI 0.5-0.8]). However, even in this most recent period, the risk for nontraumatic LEAs among these relatively young patients was 86-fold higher than that in the matched general population (SIR 85.8 [72.9-100.3]). By age 65 years, the cumulative probability of having a nontraumatic LEA was 11.0% for women with type 1 diabetes and 20.7% for men with type 1 diabetes.

Conclusions: Although the risks appeared to have declined in recent years, patients with type 1 diabetes still have a very high risk for nontraumatic LEAs.


Figure 1
Figure 1
The cumulative probability of nontraumatic LEA among type 1 diabetic patients, estimated by the Kaplan-Meier method.

Similar articles

See all similar articles

Cited by 19 PubMed Central articles

See all "Cited by" articles


    1. Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J: The global burden of diabetic foot disease. Lancet 366:1719–1724, 2005 - PubMed
    1. Jeffcoate WJ, Harding KG: Diabetic foot ulcers. Lancet 361:1545–1551, 2003 - PubMed
    1. Singh N, Armstrong DG, Lipsky BA: Preventing foot ulcers in patients with diabetes. JAMA 293:217–228, 2005 - PubMed
    1. Apelqvist J, Bakker K, van Houtum WH, Nabuurs-Franssen MH, Schaper NC: International consensus and practical guidelines on the management and the prevention of the diabetic foot: International Working Group on the Diabetic Foot. Diabetes Metab Res Rev 16(Suppl. 1):S84–S92, 2000 - PubMed
    1. Horgan O, MacLachlan M: Psychosocial adjustment to lower-limb amputation: a review. Disabil Rehabil 26:837–850, 2004 - PubMed

Publication types