Reduction in Diabetes-Related Lower-Extremity Amputations in the Netherlands: 1991–2000

TLDR

Lower‑extremity amputation is a common complication of diabetes worldwide, yet data on the impact of improved diabetic foot ulcer management on its incidence are scarce. The study aimed to determine the incidence of lower‑extremity amputations among Dutch diabetic patients from 1991 to 2000. Using the Dutch National Medical Register, the authors identified all hospital admissions for lower‑extremity amputations, linked them to unique patient identifiers, and calculated age‑ and sex‑specific diabetes prevalence rates to estimate the at‑risk population. Incidence of amputations fell from 55.0 to 36.3 per 10,000 diabetic patients (a 36–38 % reduction in men and women), accompanied by shorter hospital stays (from 45.0 to 36.2 days).

Abstract

Lower-extremity amputation is a common complication among patients with diabetes throughout the world. However, few data exist on the actual impact of the recent moves to improve the management of diabetic foot ulcers to reduce the incidence of lower-extremity amputations. The aim was to determine the incidence of lower-extremity amputations among diabetic patients from 1991 to 2000 in The Netherlands.A secondary database containing information regarding all hospital admissions in which a lower-extremity amputation occurred for the years 1991-2000 was obtained from the Dutch National Medical Register. Because a patient-unique identifier was included, multiple amputations and hospitalizations for a single individual could be identified. Furthermore, age- and sex-specific diabetes prevalence rates were calculated using a 3-year average for every year, calculating the total diabetic population in the Netherlands at risk for every year.In 1991, a total of 1,687 patients with diabetes had been admitted 1,865 times for 2,409 amputations. In 2000, a total of 1,673 patients with diabetes were admitted 1,932 times for 2,448 amputations. The overall incidence rates of the number of patients who underwent lower-extremity amputation decreased over the years from 55.0 to 36.3 per 10,000 patients with diabetes (P < 0.05). Both in men (71.8 vs. 46.1, P < 0.05) and women (45.0 vs. 28.0, P < 0.05) with diabetes, a significant decrease could be observed. Mean duration of hospitalization decreased from 45.0 days (SD 44.4) in 1991 to 36.2 days (SD 38.4) in 2000; decreases were observed for both men and women.Over the years observed in this study, the incidence rates of diabetes-related lower-extremity amputation in The Netherlands was found to decrease in both men (36%) and women (38%) with diabetes. Furthermore, the duration of hospitalization decreased over time.