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Lower-Extremity Amputation in People With Diabetes: Epidemiology and Prevention
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1989
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Lower‑extremity amputation rates among people with diabetes are about 15 times higher than in non‑diabetics, with over 50,000 procedures performed in 1985, largely driven by peripheral neuropathy, peripheral vascular disease, inadequate foot care, and infection. Many issues related to the etiology and prevention of LEAs require further research. Effective foot‑care programs in primary care should identify high‑risk patients, conduct clinical evaluations, provide preventive therapy and treatment, offer education, refer to specialists and shoe fitters as needed, and monitor outcomes. Several large clinical centers have experienced a 44–85 % reduction in the rate of amputations among individuals with diabetes after the implementation of improved foot‑care programs.
The age-adjusted rate of lower-extremity amputation (LEA) in the diabetic population is ∼15 times that of the nondiabetic population. Over 50,000 LEAs were performed on individuals with diabetes in the United States in 1985. Among individuals with diabetes, peripheral neuropathy and peripheral vascular disease (PVD) are major predisposing factors for LEA. Lack of adequate foot care and infection are additional risk factors. Several large clinical centers have experienced a 44–85% reduction in the rate of amputations among individuals with diabetes after the implementation of improved foot-careprograms. Programs to reduce amputations among people with diabetes in primarycare settings should identify those at high risk; clinically evaluate individuals to determine specific risk status; ensure appropriate preventive therapy, treatment for foot problems, and follow-up; provide patient education;and, when necessary, refer patients to specialists, including health-care professionals for diagnostic and therapeutic interventions and shoe fitters for proper footwear. Programs should monitor and evaluate their activities andoutcomes. Many issues related to the etiology and prevention of LEAs requirefurther research.