Diabetes- and Nondiabetes-Related Lower Extremity Amputation Incidence Before and After the Introduction of Better Organized Diabetes Foot Care

Abstract

OBJECTIVE -There is a lack of continuous longitudinal population-based data on lower extremity amputation (LEA) in the U.K. We present here accurate data on trends in diabetesrelated (DR) LEAs and non-DRLEAs in the South Tees area over a continuous 5-year period.RESEARCH DESIGN AND METHODS -All cases of LEA from 1 July 1995 to 30 June 2000 within the area were identified. Estimated ascertainment using capture-recapture analysis approached 100% for LEAs in the area. Data were collected longitudinally using the standard method of the Global Lower Extremity Amputation Study protocol.RESULTS -Over 5 years there were 454 LEAs (66.3% men) in the South Tees area, of which 223 were diabetes related (49.1%). Among individuals with diabetes, LEA rates went from 564.3 in the first year to 176.0 of 100,000 persons with diabetes in the fifth year. Over the same period, non-DRLEAs increased from 12.3 to 22.8 of 100,000 persons without diabetes. The relative risk of a person with diabetes undergoing an LEA went from being 46 times that of a person without diabetes to 7.7 at the end of the 5 years. The biggest improvement in LEA incidence was seen in the reduction of repeat major DRLEAs.CONCLUSIONS -Our data show that in the South Tees area at a time when major non-DRLEA rates increased, major DRLEA rates have fallen. These diverging trends mark a significant improvement in care for patients with diabetic foot disease as a result of better organized diabetes care.

The diabetic foot: grand overview, epidemiology and pathogenesis

“…In early 2008, Canavan et al reported that diabetes-related lower extremity amputations in the North of England reduced over a 5-year period of time during which improvements in the organization of diabetes care were implemented [16].…”

Intervention of Diabetes Foot Care Practices on the Prevention of New Diabetic Foot Ulcers in Patients with Type 2 Diabetes Mellitus

“…Moreover, treatment itself is very challenging and often needs to be long lasting. It requires not only expert interference, orthopaedic appliances and antimicrobial drugs but also costly topical dressings and inpatient care [22]. Not surprisingly, this leads to substantial economic burden.…”

“…Several factors are involved in the development of foot ulcers, including peripheral neuropathy, PVD, limited joint mobility and repeated trauma from abnormal load distribution on the foot [22]. The underlying causes of foot ulcers are usually irreversible and chronically progressive.…”

“…This, however, may be attributable to improvements in ulcer treatment and therefore does not necessarily support cost effectiveness of preventive efforts. The importance of patient education is outlined by several review articles [22].…”

Diabetiske fotsårteam i norske sykehus

“…This is deemed to enable a more systematic treatment of diabetic foot ulcers, a shorter period of healing, and fewer amputations resulting from foot ulcers (14)(15)(16).…”