Trends in Lower-Extremity Amputations in People With and Without Diabetes in Spain, 2001–2008

Abstract

OBJECTIVETo examine trends in nontraumatic lower-extremity amputations (LEAs) over an 8-year period in patients with and without diabetes in Spain.RESEARCH DESIGN AND METHODSWe identified all patients who underwent an LEA using national hospital discharge data. Discharges were grouped by diabetes status: type 1 diabetes, type 2 diabetes, and no diabetes. The incidence of discharges attributed to amputations were calculated overall and stratified by diabetes status and year. We calculated length of stay and in-hospital fatality stratified by diabetes status and type of LEA.RESULTSFrom 2001 to 2008, 46,536 minor LEAs and 43,528 major LEAs were performed. In patients with type 1 diabetes, the incidence of minor and major amputations decreased significantly from 2001 to 2008 (0.88–0.43 per 100,000 inhabitants and 0.59–0.22 per 100,000 inhabitants, respectively). In patients with type 2 diabetes, the incidence of minor and major LEAs increased significantly (9.23–10.9 per 100,000 inhabitants and 7.12–7.47 per 100,000 inhabitants). Hospital stay was similar among type 1 diabetic and type 2 diabetic subjects, according to the type of LEA. Only in-hospital mortality for minor LEAs among type 1 diabetic subjects decreased significantly (4.0% in 2001 vs. 1.6% in 2008).CONCLUSIONSOur national data show a decrease in the incidence of major and minor LEAs in patients with type 1 diabetes and an increase among patients with type 2 diabetes. Further improvement is necessary in the preventive care and early treatment of patients with diabetes. The management of foot lesions, especially among type 2 diabetic patients, is particularly urgent.

National trends in incidence and outcomes in lower extremity amputations in people with and without diabetes in Spain, 2001–2012

“…Reasons for the high ratio of minor-to-major amputations in Spain may be associated with the performing of more conservative limb-salvage procedures and increasingly more aggressive treatment of peripheral arterial disease in these patients [20]; however, with observational data we are unable to establish whether the drop in Our data show that the male sex is at higher risk for LEAs than females, confirming the data that emerged from previously published studies [4,18,25]. However, although the prevalence of diagnosed diabetes has increased considerably in men, it may not fully explain the increasing male predominance in LEAs [26].…”

“…As the prevalence of diabetes increases, the number of LEAs in people with diabetes will go up [1]. A recent report showed an increase in major and minor amputations in patients with T2DM, while the number of T1DM -related LEAs decreased in Spain between 2001 and 2008 [4]. However, in Europe the principal trend is a reduction in major amputation rates, and in some countries the improvement observed in the incidence of amputation could be related to the implementation of the recommendations published by the International Working Group on the Diabetic Foot or as a benefit of the Multidisciplinary Diabetic Foot Units (MDFU) [5][6][7][8][9][10].…”

“…Rubio et al reported that the incidence of LEAs showed a significant reduction in major amputations in people with diabetes following the introduction of an MDFU (6.1 per 100,000 in the 2001-2007 period vs. 4.0 per 100,000 per year in the 2008-2011 period) in Spain [10]. Another Spanish group reported a significant decrease in the proportion of total major amputations (47%) in the period 2001-2012 period after the implementation of better foot care [11].…”

Subsequent ischemic events associated with lower extremity amputations in patients with type 2 diabetes: A population-based cohort study

“…than DM patients without LEAs. One study conducted in England showed similar findings [8], and a study conducted in Spain detected increases in LEAs among people with Type 2 DM, while decreases in people with Type 1 DM [15]. However, other regions did not have the same experience.…”

Diabetes-Related Lower Extremities Amputations in Saudi Arabia: The Magnitude of the Problem

“…the major: minor ratio, which is important in proper evaluation of improvements KSA: Kingdom of Saudi Arabia * Table 2, ** Table 3, *** Table 4 in care organization and multidisciplinary-centered protocols. 19,20) Similar to developed countries 21) such registries will give opportunities for cross-national learning to improve health system performance. It will also help in assessing the outcomes of newer modalities of treatment.…”