London | A significant reduction in diabetes related amputations has been seen since the mid 1990s, thanks to improvements in diabetes care over this period, researchers have found. Amputations of the lower limbs are one of the most serious and disabling complications of diabetes, and become necessary when the nerve and blood vessel damage caused by the condition affects the blood supply to the lower limbs.
Serious problems with the feet including ulceration are a frequent reason for hospitalisation among patients who have diabetes. Researchers at the Odense University Hospital in Denmark analysed amputation rates in the Funen region of Denmark (with 0.5 million residents and regarded as representative of both the population of Denmark as a whole and other high income countries of Europe and the world) during the period 1996-2011.
Amputations were identified from the administrative system, diabetes status by linkage with the Danish National Diabetes Register, and mortality and population data were extracted from Statistics Denmark and the Civil Registration System. The analysis showed major reductions in diabetes related amputations of various types.
The researchers found an annual reduction in below ankle amputation (BAA) rates among diabetes patients of 10 per cent and the annual reduction in below knee amputation (BKA) rates for patients with diabetes was 15 per cent; for above knee amputations (AKA), the annual rate of reduction for those with diabetes was around 3 per cent but not statistically significant. Amputation rates unrelated to diabetes (for example, those caused by vascular diseases and ischaemia) remained unchanged over this period.
During the period 1996-2011, a total of 2,832 amputations were performed of which 1,285 were among patients with diabetes and 1,547 among individuals without diabetes. Diabetes patients had an 11 times increased rate of BAA relative to persons without diabetes. For BKA, there was an approximately seven times increased rate, and for AKA there was a four times increased rate. The researchers believe that better care related to diabetes and its complications, such as improved drugs and inspection and self care of foot ulcers that can get worse until they require amputation, are the central cause of the reduced amputation rates.
Our study suggests that the reduction in amputation rates among diabetes patients most likely is due to improvement in the care of individuals with diabetes, the researchers said. The introduction of vascular surgery and improved surgical techniques cannot explain our findings, since these procedures are applied equally in individuals with and without diabetes, they said.
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