The Epidemiology of Lower Extremity Amputations in Diabetic Individuals

Abstract

The Diabetes Control Activity has established diabetes control programs in 20 states. Each has investigated the extent and nature of diabetes morbidity within its state by means of a descriptive analysis of selected health status indicators. Data from six states are included: 100% of hospital discharges from Rhode Island, South Carolina, and Maine and approximately 50% from Minnesota, Illinois, and Ohio were pooled to provide a profile of lower extremity amputations (LEA) in diabetic individuals. The purposes of this study were to identify diabetic persons at high risk of amputation for targeting preventive programs as well as to establish a baseline for monitoring trends over time. Discharge data provided by hospital abstracting services were examined for 1976-1978. Results indicate that 45% of all LEAs are performed on patients with diabetes. An age-adjusted LEA rate of 59.7/10,000 diabetic individuals was computed. Diabetes-related amputation rates increase with age and are higher in males. The overwhelming majority of LEAs are either toe or above the knee, with few performed on the foot. The relative risk of LEAs for the diabetic compared with the nondiabetic population is highest in the under-45 age group (28), although the attributable risk is highest in the older population (91.5/10,000 diabetic individuals). Overall, diabetic persons have a 15 times higher risk of LEA than nondiabetic individuals.

Therapeutic angiogenesis induced by human hepatocyte growth factor gene in rat and rabbit hindlimb ischemia models: preclinical study for treatment of peripheral arterial disease

“…In patients with critical limb ischemia, since there is no pharmacological treatment, amputation, despite its associated morbidity, mortality, and functional implications, 1,21,22 is often recommended as a solution to the disabling symptoms, in particular excruciating ischemic rest pain. [22][23][24] Indeed, a second major amputation is required in nearly 10% of such patients.…”

Impaired Biomechanical Properties of Diabetic Skin

“…2 Diabetesrelated admissions accounted for 22% of all hospital inpatient days in 2007, and diabetic foot ulcers account for 20% of all hospital admissions in diabetic patients, which are the leading cause of lower extremity amputations. 2 Improvements made in diabetic wound management and prevention clearly have the potential to affect a large number of patients and decrease diabetic-related health care expenditures.More than 100 factors have been identified that contribute to the impairment in diabetic wound healing. 3 Decreased angiogenesis, 4 impaired growth factor production, 5 an altered inflammatory and immune response, 5 a decreased rate of wound contraction, 6 and an imbalance between the accumulation of extracellular components and their remodeling by matrix metalloproteinases (MMPs) 7,8 have all been demonstrated in diabetic wounds.…”

“…2 Diabetesrelated admissions accounted for 22% of all hospital inpatient days in 2007, and diabetic foot ulcers account for 20% of all hospital admissions in diabetic patients, which are the leading cause of lower extremity amputations. 2 Improvements made in diabetic wound management and prevention clearly have the potential to affect a large number of patients and decrease diabetic-related health care expenditures.…”

Current practice in the assessment and management of acute diabetes-related foot complications

“…1,2 People with diabetes mellitus have a 15 times increased risk of undergoing a lower extremity amputation when compared with those without diabetes. 1 In Australia, between 1995 and 1998 there were 2629 lower extremity amputations performed on those with diabetes annually, equating to 13.97 amputations per 100 000 population. 2 In the United States, this rate is considerably higher at 25.2 per 100 000 population.…”