Lower-extremity amputations in people with and without diabetes in Germany, 2008–2012 – an analysis of more than 30 million inhabitants

Abstract

Background and purposeLower-extremity amputations (LEAs) in people with diabetes are associated with reduced quality of life and increased health care costs. Detailed knowledge on amputation rates (ARs) is of utmost importance for future health care and economics strategies. We conducted the present cohort study in order to estimate the incidences of LEA as well as relative and attributable risk due to diabetes and to investigate time trends for the period 2008–2012.MethodsOn the basis of the administrative data from three large branches of German statutory health insurers, covering ~34 million insured people nationwide (about 40% of the German population), we estimated age-sex-standardized AR (first amputation per year) in the populations with and without diabetes for any, major, and minor LEAs. Time trends were analyzed using Poisson regression.ResultsA total of 108,208 individuals (diabetes: 67.3%; mean age 72.6 years) had at least one amputation. Among people with diabetes, we observed a significant reduction in major and minor ARs during 2008–2012 from 81.2 (95% CI 77.5–84.9) to 58.4 (55.0–61.7), and from 206.1 (197.3–214.8) to 177.0 (169.7–184.4) per 100,000 person-years, respectively. Among people without diabetes, the major AR decreased significantly from 14.3 (13.9–14.8) to 11.6 ([11.2–12.0], 12.0), whereas the minor AR increased from 15.8 (15.3–16.3) to 17.0 (16.5–17.5) per 100,000 person-years. The relative risk (RR) comparing the diabetic with the nondiabetic populations decreased significantly for both major and minor LEAs (4% and 5% annual reduction, respectively).ConclusionIn this large nationwide population, we still found higher major and minor ARs among people with diabetes compared with those without diabetes. However, AR and RR of major and minor LEAs in the diabetic compared with the nondiabetic population decreased significantly during the study period, confirming a positive trend that has been observed in smaller and regional studies in recent years.

Amputation rates of the lower limb by amputation level – observational study using German national hospital discharge data from 2005 to 2015

“…However different approaches regarding the inclusion of cases and the definition of amputation levels hamper a direct comparison of results. Nevertheless several international studies also captured decreases in major amputations and increases in minor amputations [2, 6, 12–17, 23] as well as higher decreases in amputation rates within women than men [2, 6, 14, 16, 23].…”

An Exploratory Research of 18 Years on the Economic Burden of Diabetes for the Romanian National Health Insurance System

“…The correct treatment administered in time is the main condition for the diabetic patient's health, being essential for the prevention of the diabetes mellitus complications. A bad patient condition may require extra care or hospitalization [53][54][55], and also, it can also lead to early retirement or even early mortality. All these represent additional expenditures from the budget of social insurance.…”

“…Different studies are presented the burden of diabetes complications on the healthcare budget [53][54][55]. Di Giovanni et al highlighted that diabetic foot disease has higher costs and leads to the worst consequences, as well as lower extremity amputation (LEA) [53].…”

“…Di Giovanni et al highlighted that diabetic foot disease has higher costs and leads to the worst consequences, as well as lower extremity amputation (LEA) [53]. These worsen the quality of life and increase the cost [54,55]. Taking into account that patients with major amputations have more than 3 comorbidities (adjOR 2.51, 95%CI: 1.75-3.60) and those with minor amputation have 2 comorbidities (adjOR 0.51, 95%CI: 0.42-0.64) [53], the cost of diabetes can be much higher.…”

“…Because of the higher frequency of LEA among the young people, DM is a major healthcare problem. Thus, the authors emphasized the need to implement different program for screening and patients' education in diabetes foot care [55] and to elaborate national guidelines [54,55].…”