The epidemiology of lower extremity amputations in diabetic individuals

The Diabetes Control Activity has established diabetes control programs in 20 states. Each has investigated the extent and nature of diabetes morbidity within its state by means of a descriptive analysis of selected health status indicators. Data from six states are included: 100% of hospital discharges from Rhode Island, South Carolina, and Maine and approximately 50% from Minnesota, Illinois, and Ohio were pooled to provide a profile of lower extremity amputations (LEA) in diabetic individuals. The purposes of this study were to identify diabetic persons at high risk of amputation for targeting preventive programs as well as to establish a baseline for monitoring trends over time. Discharge data provided by hospital abstracting services were examined for 1976-1978. Results indicate that 45% of all LEAs are performed on patients with diabetes. An age-adjusted LEA rate of 59.7/10,000 diabetic individuals was computed. Diabetes-related amputation rates increase with age and are higher in males. The overwhelming majority of LEAs are either toe or above the knee, with few performed on the foot. The relative risk of LEAs for the diabetic compared with the nondiabetic population is highest in the under-45 age group (28), although the attributable risk is highest in the older population (91.5/10,000 diabetic individuals). Overall, diabetic persons have a 15 times higher risk of LEA than nondiabetic individuals.