Decreasing amputation rates in patients with diabetes—a population‐based study

Schofield, Christopher J.; Yu, Ning; Jain, Amar; Leese, Graham

doi:10.1111/j.1464-5491.2009.02770.x

Cited by 53 publications

(57 citation statements)

References 23 publications

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“…Our incidence for lower extremity amputation of 1.4 per 10 000 population falls in the middle range of a 10-centre study [10]. Our diabetes-related amputation rate of 0.9 per 10 000 population is much less that the rates if 2.8-43.9 per 10 000 population in one review from the 1990s [11] and less than diabetes-related rates found in Scotland (1.5 per 10 000 in 2006, in a population with diabetes prevalence of 3.8%) [12], even though the prevalence of diabetes is likely to be higher in Lebanon (13.7% in 1995) [13]. In a previous study, differences in the known prevalence of diabetes did not account for the differences in overall amputation rates between centres [10].…”

Section: Incidencementioning

confidence: 84%

Diabetes or war? Incidence of and indications for limb amputation in Lebanon, 2007

Yaghi¹,

Yaghi²,

McDonald³

et al. 2012

East Mediterr Health J

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Chronic diseases such as diabetes and vascular disease are a major public health problem in Lebanon, where primary care is not well developed. This study aimed to describe the incidence and indications for limb amputation in Lebanon and identify associated factors (age, sex, level of surgery, length of hospital stay). There were 1.6 amputations per 10 000 persons. The rate of amputation was highest in southern Lebanon at 3.8 per 10 000. The most important indication for surgery was diabetes (59%). Diabetic patients were older (mean age 73 years versus 30 years), more likely to have major surgery (OR = 7.87; 95% CI: 2.83-21.9) and stay in hospital longer (RR = 4.56, 95% CI: 2.41-8.64) than patients with trauma-related amputation. Diabetes prevention, detection and management should be prioritized in any attempt to reduce the current incidence of amputation in Lebanon. RÉSUMÉ Des maladies chroniques telles que le diabète et les maladies vasculaires sont un problème de santé publique majeur au Liban, où les soins de santé primaires ne sont pas bien développés. L'étude visait à décrire l'incidence et les indications des amputations au Liban et à déterminer les facteurs associés (âge, sexe, niveau de chirurgie, durée de l'hospitalisation). L'étude a comptabilisé 1,6 amputation pour 10 000 personnes. Le sud du Liban présentait le taux d'amputation le plus élevé avec 3,8 amputations pour 10 000. Le diabète était l'indication la plus importante pour une chirurgie (59 %). Les patients diabétiques étaient plus âgés (âge moyen 73 ans par rapport à 30 ans), étaient plus susceptibles de subir une intervention chirurgicale importante (OR = 7,87 ; IC à 95 % : 2,83-21,9) et de séjourner plus longtemps à l'hôpital (RR = 4,56 ; IC à 95 % : 2,41-8,64) que les patients ayant eu une amputation suite à un traumatisme. La prévention du diabète, son dépistage et sa prise en charge doivent devenir prioritaires afin de tenter de réduire l'incidence actuelle des amputations au Liban.

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Section: Incidencementioning

confidence: 84%

Diabetes or war? Incidence of and indications for limb amputation in Lebanon, 2007

Yaghi¹,

Yaghi²,

McDonald³

et al. 2012

East Mediterr Health J

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“…Several studies in the US and western Europe in recent years have reported decreasing incidence of LEAs in DM populations particularly in response to implementation of improved diabetes foot care (Krishnan et al, 2008;Schofield et al, 2009). In the 5 year longitudinal study by Canavan et al (2008), the incidence rate of LEA in persons with DM dropped from 310.5 per 100,000 persons to 75.9 per 100,000.…”

Section: Diabetic Foot Ulcers and Lower Extremity Amputationmentioning

confidence: 99%

Diabetic foot ulceration and amputation

Burns¹,

Jan²

2012

Rehabilitation Medicine

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“…A sustained reduction in diabetes‐related lower limb amputation was observed after the institution of job‐planned multidisciplinary secondary care diabetic foot clinics 13, 14, 15, while an earlier report showed a continued high amputation incidence over a decade where no restructuring of services was undertaken 16. Diabetes foot care services in England are commissioned by Clinical Commissioning Groups (CCGs).…”

Section: Introductionmentioning

confidence: 99%

Diabetes‐related major lower limb amputation incidence is strongly related to diabetic foot service provision and improves with enhancement of services: peer review of the South‐West of England

Paisey

Abbott

Levenson³

et al. 2017

Diabet. Med.

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AimsTo investigate the relationship between high diabetes‐related lower limb amputation incidence and foot care services in the South‐West region of England.MethodsThe introduction of 10 key elements of foot care service provision in one area of the South‐West resulted in stabilization of foot ulcer incidence and sustained reduction in amputation incidence from 2007. Services introduced included administrative support, standardized general practice foot screening, improved community podiatry staffing, hospital multidisciplinary foot clinics, effective care pathways, availability of an orthotist and audit. Peer reviews of the region's diabetes foot care services were undertaken to assess delivery of these service provisions and compare this with major amputation incidence in other regions with data provided by Yorkshire and Humber Public Health Observatory Hospital Episode Statistics. Recommendations were made to improve service provision. In 2015 changes in service provision and amputation incidence were reviewed.ResultsInitial reviews in 2013 showed that the 3‐year diabetes‐related major amputation incidence correlated inversely with adequate delivery of diabetes foot care services (P=0.0024, adjusted R 2 =0.51). Repeat reviews in 2015 found that two or more foot care service improvements were reported by six diabetes foot care providers, with improvement in outcomes. The negative relationship between major amputation incidence and service provision remained strong both in the period 2012–2015 and in the year 2015 only (P ≤0.0012, adjusted R 2 =0.56, and P= 0.0005, R 2=0.62, respectively).ConclusionsMajor diabetes‐related lower limb amputation incidence is significantly inversely correlated with foot care services provision. Introduction of more effective service provision resulted in significant reductions in major amputation incidence within 2 years. Failure to improve unsatisfactory service provision resulted in continued high amputation incidence.

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Decreasing amputation rates in patients with diabetes—a population‐based study

Abstract: There has been a significant reduction in the incidence of major lower extremity amputation in patients with diabetes over the 7-year period.

Cited by 53 publications

References 23 publications

Diabetes or war? Incidence of and indications for limb amputation in Lebanon, 2007

Diabetes or war? Incidence of and indications for limb amputation in Lebanon, 2007

Diabetic foot ulceration and amputation

Diabetes‐related major lower limb amputation incidence is strongly related to diabetic foot service provision and improves with enhancement of services: peer review of the South‐West of England

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