[Incidence of lower extremity amputations in diabetics]

The aim of this study was to identify the incidence of lower extremity amputations (LEAs) in diabetics in Poland as background data for comparisons over time and with other communities. This was a cross-sectional study of the incidence of any non-traumatic and non-neoplastic LEAs in the population of Krakow region (1,239,703 inhabitants in its borders before 1.1.1999). It was calculated that for this population size it was sufficient to collect data for one year. The amputees had to be inhabitants of the Krakow region between 1.1.1996 and 31.12.1996. Data was collected from two sources: surgical wards and limb fitting centres. 290 non-traumatic and non-neoplastic LEAs were identified: 283 in the first source (hospital), of which 51 were found in the second (limb fitting centre) while 7 amputations were identified in the second source solely. 72.4% of LEAs were performed in males and this proportion tended to decrease with age, especially in diabetics. Mean age of the amputees was 64.7 years. Diabetics were significantly older (68.2 vs 61.5 years, p < 0.001). The number of amputations was growing with age reaching peak values between 65-74 years in diabetics and 55-64 in non-diabetics. 47.9% of LEAs were performed in diabetics. In 10.8% of cases diabetes was previously unknown. 88.7% of amputations were primary. The following amputation levels were identified: toe--15.5%, metatarsus--6.6%, ankle 1.0%, crus--20.0%, thigh--56.9%. In diabetics 21.6% of amputations were minor (metatarsus and below) comparing to 9.9% in non-diabetics. Incidence rates, calculated per 100,000/year and corrected using capture-recapture method, were as follows (95% confidence intervals in parentheses): 25.9 (10.2-41.6) in the whole population, 186.7 (125.3-248.1) in diabetics, 165.3 (110.5-220.0) primary in diabetics, and 14.4 (3.5-25.4) in non-diabetics. Comparing to data from the literature these were comparatively good results for diabetics of caucasian race. Like in other papers incidence rate in diabetics was almost 15 times higher than in non-diabetics, reaching 24 in females, which suggested that gender protection was reduced by diabetes. In an attempt to lower the rate of amputations several actions should be considered. They may include more active case finding, particularly by GPs, and more effective screening for a high risk diabetic foot.