Diabetes and Nontraumatic Lower Extremity Amputations: Incidence, risk factors, and prevention—a 12-year follow-up study in Nauru

Humphrey, Alistair; Dowse, Gary K.; Thoma, K; Zimmet, Paul

doi:10.2337/diacare.19.7.710

Cited by 85 publications

(48 citation statements)

References 11 publications

(21 reference statements)

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“…Generally, the incidence density of LEA of the diabetic cohort noted in our study was lower than that of previous studies (17)(18)(19)(20)(21)(22). A relatively low incidence (23,24) and prevalence (25) rate of LEA among diabetic patients was also previously reported in Eastern-Asian ethnic groups.…”

Section: Discussioncontrasting

confidence: 55%

Age and Sex May Significantly Interact With Diabetes on the Risks of Lower-Extremity Amputation and Peripheral Revascularization Procedures

Chen

Ho²,

Li³

2006

Diabetes Care

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OBJECTIVE -Using the National Health Insurance claim data, we prospectively investigated the age-and sex-specific incidence density and relative hazards of nontraumatic lowerextremity amputation (LEA) and peripheral revascularization procedure (PRP) of the diabetic population in Taiwan.RESEARCH DESIGN AND METHODS -A total of 500,868 diabetic patients and 500,248 age-and sex-matched control subjects, selected from the ambulatory care claim (1997) and the registry for beneficiaries, respectively, were linked to inpatient claims (1997)(1998)(1999)(2000)(2001)(2002) to identify hospitalizations due to nontraumatic LEA and PRP. Incidence density was calculated under the Poisson assumption, and the Kaplan-Meier analysis was used to assess the cumulative event rates over a 6-year follow-up period. We also evaluated the age-and sex-specific relative hazards of nontraumatic LEA and PRP in relation to diabetes with Cox proportional hazard regression model adjusted for demographics and regional areas.RESULTS -The estimated incidence density of nontraumatic LEA and PRP for diabetic men was 410.3 and 317.0 per 100,000 patient-years, respectively. The corresponding data for diabetic women were relatively low at 115.2 and 86.0 per 100,000 patient-years. Compared with control subjects with the same age and sex, diabetic patients consistently suffered from significantly elevated relative hazards of nontraumatic LEA. Young and female patients were especially vulnerable to experience increased risks of nontraumatic LEA, but such effect modification by age and sex was less apparent for PRP.CONCLUSIONS -Multidisciplinary diabetes foot care systems, including the provision of revascularization procedures, should be further enforced to reduce subsequent risks of nontraumatic LEA, especially in young and female diabetic patients. Diabetes Care

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Section: Discussioncontrasting

confidence: 55%

Age and Sex May Significantly Interact With Diabetes on the Risks of Lower-Extremity Amputation and Peripheral Revascularization Procedures

Chen

Ho²,

Li³

2006

Diabetes Care

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“…A selection of recent epidemiological data [11,12,13,14,15,16,17] on ulceration and amputation is listed in Table 1. Two studies from northern European countries reported the annual incidence of foot ulcers in the general diabetes population to be just over 2% [12,13].…”

Section: Epidemiologymentioning

confidence: 99%

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

2004

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Diabetic foot ulceration represents a major medical, social and economic problem all over the world. While more than 5% of diabetic patients have a history of foot ulceration, the cumulative lifetime incidence may be as high as 15%. Ethnic differences exist in both ulcer and amputation incidences, with both being less common in patients of Indian subcontinent origin living in the UK. Foot ulceration results from the interaction of several contributory factors, the most important of which is neuropathy. With respect to the management of acute Charcot neuroarthropathy in diabetes, recent studies suggest that bisphosphonates reduce disease activity as judged not only by differences in skin temperature, but also by assessing markers of bone turnover. The use of the total-contact cast is demonstrated in the treatment of acute Charcot feet and of plantar neuropathic ulcers. Histological evidence suggests that pressure relief results in chronic foot ulcers changing their morphological appearance by displaying some features of an acute wound. Thus, repetitive stresses on the insensate foot appear to play a major role in maintaining ulcer chronicity. It is hoped that increasing research activity in foot disease will ultimately result in fewer ulcers and less amputation in diabetes.

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“…On the other hand, the incidence of amputations in diabetic individuals dropped significantly in Alaska Natives after a footcare program was instituted (10). Also, in Nauru, the incidence of amputations decreased after the commencement of a national foot care education and prevention campaign in 1992 (11). In American Indians, a 48% reduction of amputations due to diabetes was demonstrated after the implementation of systematic practice…”

mentioning

confidence: 91%

Unchanged Incidence of Lower-Limb Amputations in a German City, 1990–1998

Haastert²,

et al. 2001

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OBJECTIVE -A reduction of diabetes-related amputations by at least one-half within 5 years was declared a primary objective for Europe (St. Vincent Declaration, 1989). We collected data about incidence rates of amputations in one German city (Leverkusen, with a population of ϳ160,000 inhabitants) between 1990 and 1998 to ascertain a potential change in rates of incidence. RESEARCH DESIGN AND METHODS-From all three hospitals in Leverkusen, we obtained complete lists of lower-limb amputations. From each patient record, diabetic status was determined. Only the first observed amputation was counted for the analysis. We estimated incidence rates of amputations in the entire population, the diabetic population, and the nondiabetic population. To test for time trend, we fitted Poisson regression models, adjusting for age and sex.RESULTS -During the defined period (the years 1990, 1991, and 1994 -1998), 339 patients (all residents of Leverkusen) without previous amputations had nontraumatic lower-limb amputations. Of all subjects, 46% were female. Moreover, 76% of the subjects were known to have diabetes. Mean age was 71.3 years. Incidence rates in the diabetic population (standardized to the estimated German diabetic population, per 100,000 person-years) were as follows : 1990, 549; 1991, 356; 1994, 544; 1995, 386; 1996, 426; 1997, 433; and 1998, 463. The Poisson models showed no significant change of incident amputations over time in the diabetic population or in the nondiabetic population.CONCLUSIONS -Beyond random variation, no change of incidence rates could be observed over the past 9 years. More specific interventions are needed to achieve a substantial reduction of diabetes-related amputations. Diabetes Care 24:855-859, 2001

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Diabetes and Nontraumatic Lower Extremity Amputations: Incidence, risk factors, and prevention—a 12-year follow-up study in Nauru

Cited by 85 publications

References 11 publications

Age and Sex May Significantly Interact With Diabetes on the Risks of Lower-Extremity Amputation and Peripheral Revascularization Procedures

Age and Sex May Significantly Interact With Diabetes on the Risks of Lower-Extremity Amputation and Peripheral Revascularization Procedures

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

Unchanged Incidence of Lower-Limb Amputations in a German City, 1990–1998

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