Diabetes-Related Amputations Decreased Since the 1990s

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Results from a Danish cohort revealed lower rates in amputations among patients with diabetes.
Results from a Danish cohort revealed lower rates in amputations among patients with diabetes.

Results from a Danish cohort study revealed that amputation rates among patients with diabetes have steadily declined over the past couple of decades as a result of improvements in diabetes care.

Patients with diabetes are at a higher risk for cardiovascular disease, which combined with peripheral neuropathy can lead to a diabetic foot ulcer and subsequent non-traumatic amputation. Prior studies have shown that the mortality rate after 30 days of an amputation is 30%, and 50% after 1 year, according to background information in the study, which was published in Diabetologia.

The decline of amputations among patients with diabetes has been reported in different settings and could be a result of aggressive vascular surgical approach, the researchers noted.

“It seems that a multidisciplinary approach to patients with diabetes can provide a further reduction in the rate of amputation,” the researchers wrote in their study.

The researchers examined the amputation rates from the hospital administrative system in the County of Funen from 1996 to 2011. They identified diabetes status from the Danish National Diabetes Register, and analyzed amputation incidence rates by level of amputation, and again by incidence of further amputation.

The researchers found that from 1996 to 2011, 2832 amputations were performed, and of those, 1285 were among patients with diabetes.

Men with diabetes had a hazard ratio (HR) of 14.7 (95% CI, 10.5-20.4) relative to patients without diabetes for amputations below the ankle, and women had an HR of 7.5 (95% CI, 5.2-10.9).

For amputations between the ankle and knee, the HR was 7.6 for men (95% CI, 5.2-11.3) and 8.4 for women (95% CI, 5.5-12.8). HRs for amputations above the knee were 4.0 for men (95% CI, 2.3-6.7) and 3.7 for women (95% CI, 2.2-6.2).

The annual reduction in the rate of amputations below the ankle was 9.8%, and the annual reduction in the rate of amputations between the ankle and knee was 15.1%.

“The reduction in amputations among diabetic individuals is encouraging,” the authors concluded. “It is also encouraging that the overall amputation rate is declining in most parts of the world. However, amputation rates in patients with diabetes remain high compared with individuals without diabetes, posing a great challenge for improving care.”

The results from the study suggest that the reduction of amputations is likely due to improvements in care of diabetes, and not from improvements in ischemia or neuropathy care, since amputation rates among patients without diabetes did not change.

The researchers recommend establishing additional diabetes treatment protocols to give general practitioners a screening tool to secure regular outpatient attendance and to help collaborate with specialists in the hospital.

Reference

  1. Rasmussen BSB, Yderstraede KB, Carstensen B, Skov O, Beck-Nielsen H. Substantial reduction in the number of amputations among patients with diabetes: a cohort study over 16 years. Diabetologia. 2015;doi:10.1007/s00125-015-3781-7.
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