November 24, 2015
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Amputation rate drops among patients with diabetes

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Improvements in diabetes care have led to a significant reduction in diabetes-related amputations since the mid-1990s, according to research in Diabetologia.

In an analysis of both hospital and diabetes registry data in Denmark, Benjamin S.B. Rasmussen, MD, of Odense University Hospital in Denmark, and colleagues also found that although the rate of amputations has fallen overall, the amputation rate remains high among patients with diabetes compared with those without diabetes and is higher among men than women.

“The reduction in amputations among diabetic individuals is encouraging,” the researchers wrote. “The results presented here indicate that it is beneficial to adopt a multidisciplinary approach optimized for screening and treating complications linked to diabetes.”

Rasmussen and colleagues analyzed amputation rates in Funen County, Denmark, between 1996 and 2011, using data from the hospital administrative system linked to the Danish National Diabetes Register and data on mortality and population from Statistics Denmark. Researchers analyzed incidence of first amputation at each level (below-ankle, ankle-to-knee, and above-knee amputations), as well as incidence of further amputations, subdivided at each level of amputation.

A total of 2,832 amputations were performed during the 15-year study period; 1,285 on patients with diabetes. The HR for below-ankle amputations for patients with diabetes was 14.7 for men (95% CI, 10.5-20.4) and 7.5 for women (95% CI, 5.2-10.9), relative to patients without diabetes. The HR for ankle-to-knee amputations was 7.6 for men (95% CI, 5.2-11.3) and 8.4 for women (95% CI, 5.5-12.8); the HR for above-knee amputations was 4 for men (95% CI, 2.3-6.7) and 3.7 for women (95% CI, 2.2-6.2).

Amputation rates unrelated to diabetes remained unchanged during the study period, according to researchers.

“Our study suggests that the reduction in amputation rates among patients with diabetes is most likely to be due to improvements in the care of individuals with diabetes and not to a general improvement in the treatment of patients with ischemia or neuropathy, since the amputation rate in nondiabetic individuals was unchanged,” the researchers wrote. “The introduction of vascular surgery, improved surgical techniques and empirically based antibiotic regimens cannot explain our findings, since these procedures are applied equally in individuals with and without diabetes.” – by Regina Schaffer

Disclosure: The researchers report no relevant financial disclosures.