Diabetes-related amputations reduced since 1990s

by Bruce Sylvester: Diabetes-related amputations have declined significantly since the mid-1990s, researchers reported in November, 2015 in Diabetologia, the journal of the European Association for the Study of Diabetes.

Co-authors Benjamin Rasmussen, M.D. and Henning Beck-Nielsen, M.D. of Odense University Hospital in Denmark wrote, “The reduction of amputations among diabetics is encouraging. The results presented here indicate that multidisciplinary diabetic clinics optimized for screening and treating complications linked to diabetes are beneficial. It is encouraging that the overall amputation rate is declining in most parts of the world. However, amputation rates in patients with diabetes remain high compared to individuals without DM [diabetes mellitus/Type 2 diabetes] posing a great challenge to improve care.”

The investigators analyzed retrospectively amputation rates in the Funen region of Denmark during the period 1996–2011, using diabetes data from the Danish National Diabetes Register, and mortality and population data from Statistics Denmark and the Civil Registration System.

They found a 10% annual reduction in below-ankle amputation rates among diabetes patients and an annual reduction in below-knee amputation rates for diabetes patients of 15%. For above-knee amputations, the annual rate of reduction was 3%, but not statistically significant.

Amputation rates not related to diabetes were unchanged.

Even though there were reductions in amputation rates for people with diabetes, these patients remained much more likely to have an amputation than those without diabetes. From 1996–2011, there were a total of 2,832 amputations, 1,285 of which were diabetes-related.

Diabetes subjects had an 11-fold risk of below-ankle amputation compared to subjects without diabetes. For below-knee amputation, there was a 7-fold increased risk. For above-knee amputations, there was a 4-fold increased rate.

The authors said, “Our study suggests that the reduction in amputation rates among diabetes patients most likely is due to improvement in the care of individuals with diabetes. The introduction of vascular surgery and improved surgical techniques cannot explain our findings, since these procedures are applied equally in individuals with and without diabetes. The findings in individuals with diabetes can therefore only be explained by improved diabetes care, namely improved metabolic control through drugs or lifestyle, or changes in how care is delivered, including better screening – we believe it to be both.”