Reduced Incidence of Lower-Limb Amputations in the Diabetic Population of a German City, 1990–2005

Abstract

OBJECTIVE -We evaluated whether the incidence of amputations in one German city (Leverkusen, population ϳ160,000) had decreased between 1990 and 2005. RESEARCH DESIGN AND METHODS-From all three hospitals in the city, we obtained complete lists of nontraumatic lower-limb amputations in 1990 -1991 and 1994 -2005. Only the first observed amputation in residents of Leverkusen was counted. A total of 692 patients met the inclusion criteria. Data about the population stucture, separately for each year of the observation period, were received from the city administration and the Federal Office of Statistics. To test for time trend, we fitted Poisson regression models.RESULTS -Of all subjects, 72% had known diabetes and 58% were male. Mean age was 71.7 years. Incidence rates in the diabetic population (standardized to the estimated German diabetic population per 100,000 person-years) varied considerably between years (maximum 549 in 1990, minimum 281 in 2004). In the diabetic population, the estimated relative risk (RR) per year was 0.976 (95% CI 0.958 -0.996, P ϭ 0.0164). The same trend was observed when only amputations above the ankle (n ϭ 352) , P ϭ 0.0318) were considered. Over 15 years, an estimated reduction of amputations above the toe level by 37.1% (95% CI 12.3-54.8) results. There was no significant change of incident amputations in the nondiabetic population (RR 1.022 [0.989 -1.056], P ϭ 0.1981).CONCLUSIONS -This finding is likely to be due to improved management of the diabetic foot syndrome after a network of specialized physicians and defined clinical pathways for wound treatment and metabolic control were introduced. Diabetes Care 30:2633-2637, 2007I n 1989, a reduction of the number of amputations in the diabetic population by at least one-half within 5 years was declared a primary objective for Europe (St. Vincent Declaration) (1). We published baseline data about the incidence rates of amputations in the city of Leverkusen, Germany, in 1990 and 1991, as well as follow-up data through 1998 (2,3). We found that the risk of having an amputation was 26-fold (95% CI 17-39) in the diabetic population compared with that in the nondiabetic population. Moreover, 96% (94 -97) of the amputation risk in diabetic individuals and 70% (61-77) of the amputation risk in the entire population were due to diabetes (2,3). We estimated that ϳ31,000 patients in Germany underwent first amputations per year, that 23,000 of these patients had diabetes, and that 21,000 had their amputations due to their diabetes (4). No change in incidence rates over time could be detected between 1990 and 1998 (3). In the present study, we continued the collection of these data from 1999 through 2005 and combined them with the existing dataset to ascertain a potential change in incidence rates.The incidence of amputations in diabetic individuals dropped significantly in several areas in various countries and populations, such as Alaska Natives, American Indians, Denmark, and Sweden, after various specific programs for foot care and prevention...

Amputation Statistics—How to Interpret Them?

“…This study is of great practical value: on the one hand it lucidly portrays the true extent of the amputation problem in Germany, and on the other hand it shows a positive trend towards lower numbers of major amputations year on year. The data are in agreement with the above-mentioned German studies (6,7) and with international investigations (3).…”

The impact of endovascular intervention and open surgery on the incidence of lower extremity amputations

“…In the US about 80,000 major amputations (above the ankle) are being performed annually [7,8] (24/100,000 inhabitants). The comparable data are presented by European statistics [9][10][11][12].…”

The Diabetic Foot

“…It would be interesting to ascertain what proportion is related to the progression of their disease or to the sequelae of the amputation and resulting disability. About half of these amputations can, however, be prevented by proper care [39,40].…”