Amputations and foot ulcers in patients newly diagnosed with type 2 diabetes mellitus and observed for 19 years. The role of age, gender and co-morbidity

Diabet Med. 2013 Aug;30(8):964-72. doi: 10.1111/dme.12196. Epub 2013 Apr 26.

Abstract

Aims: To determine the prevalence of foot ulcers and the incidence of amputations in patients with Type 2 diabetes observed for 19 years after diagnosis. We investigated the role of gender, age and co-morbidities.

Methods: From the Diabetes Care in General Practice study, 1381 patients were included and examined at diabetes diagnosis, at 6 years and at 14 years after diagnosis. Register-based follow-up was for 19 years. Foot ulcers and amputations were related to gender, age and co-morbidities by odds and hazard ratios from logistic and Cox regression models, respectively.

Results: The incidence of any amputation and major amputation was 400 (95% CI 307-512) and 279 (95% CI 203-375) per 100,000 patient-years, respectively. At the three observation points, the foot ulcer prevalences were 2.76% (95% CI 1.89-3.63), 2.93% (95% CI 1.86-4.00) and 4.96% (95% CI 3.10-6.82). Multivariate analyses showed associations between foot ulcers and peripheral neuropathy, peripheral arterial disease, male gender, retinopathy and myocardial infarction. After multivariate adjustment, significant predictors (hazard ratio; 95% CI) of any amputation were peripheral neuropathy (hazard ratio 2.09; 95% CI 1.19-3.69), peripheral arterial disease (hazard ratio 3.43; 95% CI 1.65-7.12), microalbuminuria (hazard ratio 2.11; 95% CI 1.21-3.67), retinopathy (hazard ratio 6.42; 95% CI 2.59-15.90), impaired vision (hazard ratio 6.92; 95% CI 2.35-20.38) and male gender (hazard ratio 2.40; 95% CI 1.31-4.41). For women, the risk of amputation increased with age, but for men the risk was higher when diagnosed with diabetes at a younger age.

Conclusions: Despite improved treatment regimens, the incidence of amputations is still high in this population-based patient sample. Men diagnosed with diabetes before age 65 years and patients with diabetes-related co-morbidities are at particularly high risk of foot ulcers and amputations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Amputation, Surgical*
  • Cohort Studies
  • Combined Modality Therapy
  • Comorbidity
  • Denmark / epidemiology
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / therapy
  • Diabetic Foot / epidemiology*
  • Diabetic Foot / physiopathology
  • Diabetic Foot / prevention & control
  • Diabetic Foot / surgery*
  • Diabetic Nephropathies / epidemiology
  • Diabetic Nephropathies / physiopathology
  • Diabetic Nephropathies / prevention & control
  • Diabetic Neuropathies / epidemiology
  • Diabetic Neuropathies / physiopathology
  • Diabetic Neuropathies / prevention & control
  • Diabetic Retinopathy / epidemiology
  • Diabetic Retinopathy / physiopathology
  • Diabetic Retinopathy / prevention & control
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Peripheral Arterial Disease / complications
  • Peripheral Arterial Disease / epidemiology
  • Peripheral Arterial Disease / physiopathology
  • Peripheral Arterial Disease / prevention & control
  • Prevalence
  • Sex Factors
  • Trauma Severity Indices