Twenty years with diabetes and amputations: a retrospective population-based cohort study

Area of Science:

• Endocrinology and Metabolic Diseases
• Vascular Surgery
• Public Health Epidemiology

Background:

• Non-traumatic lower limb amputations are a severe complication associated with diabetes.
• Understanding amputation trends is crucial for public health initiatives and resource allocation.
• Previous studies have indicated a decline in amputations, but recent trends require updated analysis.

Purpose of the Study:

• To investigate and quantify the trends in non-traumatic lower limb amputations.
• To compare amputation rates between individuals with type 1 diabetes, type 2 diabetes, and those without diabetes.
• To analyze amputation trends across different levels: trans-femoral, trans-tibial, and below the ankle.

Main Methods:

• Utilized the Danish National Patient Register to identify individuals with and without diabetes (1997-2017).
• Stratified 17,265 amputations into trans-femoral, trans-tibial, and below-ankle categories using surgical codes.
• Employed least-squares linear regression to describe annual changes in amputation incidence rates per 1000 person-years.

Main Results:

• Significant yearly decreases in amputation incidence were observed across all categories and diabetes statuses.
• Trans-tibial amputations showed the most substantial decline, particularly in individuals with type 2 diabetes (-0.090 per 1000 person-years).
• Amputations below the ankle also demonstrated significant decreases in all groups, with type 2 diabetes showing a rate of -0.075 per 1000 person-years.

Conclusions:

• The incidence of non-traumatic lower limb amputation has significantly decreased over recent decades.
• This positive trend was observed in both the diabetic population (type 1 and type 2) and the general population without diabetes.
• These findings suggest improvements in diabetes care and preventative strategies leading to reduced amputation rates.