Decreasing rates of major lower-extremity amputation in people with diabetes but not in those without: a nationwide study in Belgium

Abstract

Aims/hypothesisThe reduction of major lower-extremity amputations (LEAs) is one of the main goals in diabetes care. Our aim was to estimate annual LEA rates in individuals with and without diabetes in Belgium, and corresponding time trends.MethodsData for 2009–2013 were provided by the Belgian national health insurance funds, covering more than 99% of the Belgian population (about 11 million people). We estimated the age–sex standardised annual amputation rate (first per year) in the populations with and without diabetes for major and minor LEAs, and the corresponding relative risks. To test for time trends, Poisson regression models were fitted.ResultsA total of 5438 individuals (52.1% with diabetes) underwent a major LEA, 2884 people with above- and 3070 with below-the-knee major amputations. A significant decline in the major amputation rate was observed in people with diabetes (2009: 42.3; 2013: 29.9 per 100,000 person-years, 8% annual reduction, p < 0.001), which was particularly evident for major amputations above the knee. The annual major amputation rate remained stable in individuals without diabetes (2009: 6.1 per 100,000 person-years; 2013: 6.0 per 100,000 person-years, p = 0.324) and thus the relative risk reduced from 6.9 to 5.0 (p < 0.001). A significant but weaker decrease was observed for minor amputation in individuals with and without diabetes (5% and 3% annual reduction, respectively, p < 0.001).Conclusions/interpretationIn this nationwide study, the risk of undergoing a major LEA in Belgium gradually declined for individuals with diabetes between 2009 and 2013. However, continued efforts should be made to further reduce the number of unnecessary amputations.Electronic supplementary materialThe online version of this article (10.1007/s00125-018-4655-6) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

Major amputations in type 2 diabetes between 2001 and 2015 in Spain: regional differences

“…In European and North-American countries there has been a decrease in the incidence of nontraumatic amputations in the last decades, [16] especially at the expense of MA in patients with T2DM [17] and particularly more evident for major amputations above the knee [18]; this has been attributed to the healthcare offered to the patient with T2DM, specially the diabetic foot care programmes [4]. This decreasing trend was also reported in Spain [7,19].…”

Major amputations in type 2 diabetes between 2001 and 2015 in Spain: Regional differences.

“…In European and North-American countries there has been a decrease in the incidence of nontraumatic amputations in the last decades, [16] especially at the expense of MA in patients with T2DM [17] and particularly more evident for major amputations above the knee; [18] this has been attributed to the healthcare offered to the patient with T2DM, specially the diabetic foot care programmes. [4] This decreasing trend was also reported in Spain.…”

Reduction in Diabetes-Related Major Amputation Rates After Implementation of a Multidisciplinary Model: An Evaluation in Alberta, Canada

“…15 18 In the TFM, podiatric surgeons (toe) and vascular surgeons (flow) form the backbone of the service and are considered the irreducible minimum in the limb preservation team structure. The full integration of a specialized podiatric surgery service in tertiary academic health systems have previously shown to significantly reduce major amputation rates.19 23 Podiatric surgeons are able to assess and treat acute infections that require urgent evacuation of infection including open amputation and incision and drainage.…”