Changes in the Incidence of Lower Extremity Amputations in Individuals With and Without Diabetes in England Between 2004 and 2008

Abstract

OBJECTIVETo describe recent trends in the incidence of nontraumatic amputations among individuals with and without diabetes and estimate the relative risk of amputations among individuals with diabetes in England.RESEARCH DESIGN AND METHODSWe identified all patients aged >16 years who underwent any nontraumatic amputation in England between 2004 and 2008 using national hospital activity data from all National Health Service hospitals. Age- and sex-specific incidence rates were calculated using the total diabetes population in England every year. To test for time trend, we fitted Poisson regression models.RESULTSThe absolute number of diabetes-related amputations increased by 14.7%, and the incidence decreased by 9.1%, from 27.5 to 25.0 per 10,000 people with diabetes, during the study period (P > 0.2 for both). The incidence of minor and major amputations did not significantly change (15.7–14.9 and 11.8–10.2 per 10,000 people with diabetes; P = 0.66 and P = 0.29, respectively). Poisson regression analysis showed no statistically significant change in diabetes-related amputation incidence over time (0.98 decrease per year [95% CI 0.93–1.02]; P = 0.12). Nondiabetes-related amputation incidence decreased from 13.6 to 11.9 per 100,000 people without diabetes (0.97 decrease by year [0.93–1.00]; P = 0.059). The relative risk of an individual with diabetes undergoing a lower extremity amputation was 20.3 in 2004 and 21.2 in 2008, compared with that of individuals without diabetes.CONCLUSIONSThis national study suggests that the overall population burden of amputations increased in people with diabetes at a time when the number and incidence of amputations decreased in the aging nondiabetic population.

Predictors of Lower-Extremity Amputation in Patients With an Infected Diabetic Foot Ulcer

“…Our data were obtained in [2003][2004], and the incidence of lower-extremity amputation in patients with diabetic foot ulcers has decreased since then in several countries (28). However, studies have observed that the relative risk of amputation for these patients has not changed (29,30), which is why we believe our results are still valid and applicable.…”

Ankle-brachial index and diabetic neuropathy: study of 225 patients

“…The arterial disease, a risk factor irrespective of ulceration and amputation, is present in 50% patients with ulcers, so early detection is of great concern 16 . The International Working Group on the Diabetic Foot Guidelines suggests that, added to the symptoms of neuropathic pain, vascular insufficiency can be evaluated by a manual Doppler and calculated by an ABI of less than 0.9, to assess for possible revascularization.…”

“…The ABI reference scores are: a) > 1.3 = hardened vessels; b) from 0.9-1.3 = normal arterial flow; c) < 0.9 = arterial occlusion. The ABI measurement is recommended for all patients with diabetes over 50 years of age, or those presenting with symptoms of peripheral arterial disease or other cardiovascular risk factors 8,16,17 . Patients' DN4 scores were then subjected to ABI measurement, which was calculated by dividing the highest systolic blood pressure in the lower and upper limbs 17 .…”

Advances in the Treatment of Peripheral Vascular Disease in Diabetes and Reduction of Major Amputations

“…11 In another study, major and minor amputation rates were stable across England between 2003 and 2008, accompanied by a significant reduction in perioperative mortality. 12 Other authors have reported that there was significant reduction in the incidence of major LEA in patients with diabetes over a 7-year period (January 1, 2000 to December 31, 2006).…”