Major lower limb amputation in diabetic patients: development during 1982 to 1993

Ebskov, B; Ebskov, Lars Bo

doi:10.1007/s001250050622

Cited by 40 publications

(37 citation statements)

References 5 publications

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“…Our finding that men with type 1 diabetes have higher risks for nontraumatic LEAs than women with type 1 diabetes is consistent with previous reports (9,11,16). This more pronounced cumulative risk in men may reflect several factors, including the fact that smoking is more common among men (17) and that wounds heal more efficiently in women as a consequence of their expression of the estrogen receptor-␤ (18,19).…”

Section: Statistical Analysessupporting

confidence: 91%

Risks of Nontraumatic Lower-Extremity Amputations in Patients with Type 1 Diabetes

Jonasson

Sparén

et al. 2008

Diabetes Care

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OBJECTIVE -The purpose of this study was to estimate the risks of nontraumatic lowerextremity amputations (LEAs) in patients with type 1 diabetes. Poisson regression modeling was used to compare the risks of nontraumatic LEAs during different calendar periods of follow-up, with adjustment for both sex and attained age at follow-up. Standardized incidence ratios (SIRs) were used to estimate the relative risks (RRs) with the age-, sex-, and calendar period-matched general Swedish population as reference. The cumulative probability of nontraumatic LEAs was calculated by the Kaplan-Meier method. RESEARCH DESIGN AND METHODSRESULTS -In total, 465 patients with type 1 diabetes underwent nontraumatic LEAs. The risk was lower during the most recent calendar period (2000 -2004) than during the period before 2000 (RR 0.6 [95% CI 0.5-0.8]). However, even in this most recent period, the risk for nontraumatic LEAs among these relatively young patients was 86-fold higher than that in the matched general population ). By age 65 years, the cumulative probability of having a nontraumatic LEA was 11.0% for women with type 1 diabetes and 20.7% for men with type 1 diabetes.CONCLUSIONS -Although the risks appeared to have declined in recent years, patients with type 1 diabetes still have a very high risk for nontraumatic LEAs.

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Section: Statistical Analysessupporting

confidence: 91%

Risks of Nontraumatic Lower-Extremity Amputations in Patients with Type 1 Diabetes

Jonasson

Sparén

et al. 2008

Diabetes Care

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“…The importance of a wellfunctioning vascular service as part of the multidisciplinary approach is well recognized, and has been emphasized in many reports (Ebskov and Ebskov 1996, International Working Group on the Diabetic Foot 1999, Luther et al 2000, Holstein et al 2001, Eskelinen et al 2003, 2004.…”

Section: Discussionmentioning

confidence: 99%

Sustained reduction in major amputations in diabetic patients: 628 amputations in 461 patients in a defined population over a 20-year period

et al. 2008

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“…The data from Europe are conflicting. Various groups have reported a decrease in the total incidence of amputation in diabetes [16,18,44,53]; however, in some cases the baseline incidence was high [18,44]. Nevertheless, the decrease observed across Denmark was from a more modest baseline [53], while that in Madrid was already low [6].…”

Section: Amputation In Diabetesmentioning

confidence: 99%

Amputation as a marker of the quality of foot care in diabetes

2004

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Strategic targets for the management of foot ulcers focus on reducing the incidence of amputation. While data on the incidence of amputation can be obtained relatively easily, the figures require very careful interpretation. Variation in the definition of amputation, population selection and the choice of numerator and denominator make comparisons difficult. Major and minor amputation have to be distinguished as they are undertaken for different reasons and are associated with different costs and functional implications. Many factors influence the decision of whether or not to remove a limb. In addition to disease severity, co-morbidities, and social and individual patient factors, many aspects of the structure of care services affect this decision, including access to primary care, quality of primary care, delays in referral, availability and quality of specialist resources, and prevailing medical opinion. It follows that a high incidence of amputation can reflect a higher disease prevalence, late referral, limited resources, or a particularly interventionist approach by a specialist team. Conversely, a low incidence of amputation can indicate a lower disease prevalence or severity, good management of diabetes in primary and secondary care, or a particularly conservative approach by an expert team. An inappropriately conservative approach could conceivably enhance suffering by condemning a person to months of incapacity before they die with an unhealed ulcer. The reported annual incidence of major amputation in industrialised countries ranges from 0.06 to 3.83 per 10 3 people at risk. Some centres have documented that the incidence is falling, but this is often from a baseline value that was unusually high. Other centres have reported that the incidence has not changed. The ultimate target is to achieve not only a decrease in incidence, but also a low overall incidence. This must be accompanied by improvements in morbidity, mortality, and patient function and mood.

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Major lower limb amputation in diabetic patients: development during 1982 to 1993

Cited by 40 publications

References 5 publications

Risks of Nontraumatic Lower-Extremity Amputations in Patients with Type 1 Diabetes

Risks of Nontraumatic Lower-Extremity Amputations in Patients with Type 1 Diabetes

Sustained reduction in major amputations in diabetic patients: 628 amputations in 461 patients in a defined population over a 20-year period

Amputation as a marker of the quality of foot care in diabetes

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