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Study finds decline in diabetes related amputations

The number of diabetes-related amputations has decreased significantly since the mid-1990s due to improvements in diabetes care, according to results published online ahead of print in Diabetologia.

Benjamin Rasmussen, MD, and Henning Beck-Nielsen, DMSc, both of Odense University Hospital Denmark, and colleagues analyzed amputation rates in the Funen region of Denmark during the period of 1996 to 2011. According to a press release, the Funen region is regarded as representative of the population of Denmark, as well as other high-income countries, due to its population of 0.5 million residents.

The researchers identified amputations with the administrative system and found diabetes status with linkage to the Danish National Diabetes Register. They used the Statistics Denmark and the Civil Registration System to obtain mortality and population data.

The results showed a major reduction in amputations among people with diabetes, including a 10% annual reduction in below-ankle amputations and a 15% annual reduction in below-knee amputations. The results also showed a 3% annual rate of reduction for above-knee amputations, but this result was not statistically significant.

Amputation rates for causes unrelated to diabetes, such as vascular diseases and ischemia, remained unchanged during this period. Although amputation rates for people with diabetes declined, they still were higher than those for people without diabetes. Among the 2,832 amputations performed between 1996 and 2011, 1,285 were among patients with diabetes and 1,547 were among people without diabetes. People with diabetes were 11-times more likely to undergo below-ankle amputation; about seven-times more likely to undergo below-knee amputation; and four-times more likely to undergo above-knee amputation, according to the press release.

Rasmussen and colleagues suggested the reduced amputation rates are a result of improved care for diabetes and its complications. Metabolic control through drugs and lifestyle changes, as well as changes in care and improved screenings, all could be contributors to the improved rates, according to the authors.

Rasmussen and colleagues suggested the establishment of multidisciplinary diabetic clinics with specialties in macro- and micro-vascular diseases to continue the downward trend in amputation rates.

 

Reference:

Rasmussen B, et al. Diabetologia. 2015; [published online ahead of print Nov. 22].

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