Twenty years with diabetes and amputations: a retrospective population‐based cohort study

• Published in: Diabetic medicine 2020-12, Vol.37 (12), p.2098-2108
• Main Authors: Røikjer, J., Jensen, M. H., Vestergaard, P., Sørensen, A. M., Laursen, H. V. B., Ejskjær, N.
• Format: Article
• Language: English
• Subjects: Amputation; Ankle; Cohort analysis; Diabetes; Diabetes mellitus (insulin dependent); Diabetes mellitus (non-insulin dependent); Femur; Longitudinal studies; Population studies; Population-based studies; Trends
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.14251

Aim To investigate the trends in non‐traumatic lower limb amputation in people with and without diabetes. Methods From the Danish National Patient Register, all people with either type 1 or type 2 diabetes (n = 462 743) as well as a group of people without diabetes from the general population (n = 1 388 886) were identified and separated into three groups based on diabetes type. Among these, 17 265 amputations were identified between 1997 and 2017 and stratified into trans‐femoral amputations, trans‐tibial amputations and amputations below the ankle using surgical codes. Annual changes were described using least‐squares linear regression. Results The yearly mean decrease in incidence rate of amputation per 1000 person‐years was −0.032 [95% CI: −0.062, −0.001], −0.022 [−0.032, −0.012] and −0.006 [−0.009, −0.003] for trans−femoral amputation, −0.072 [−0.093, −0.052], −0.090 [−0.102, −0.078] and −0.015 [−0.016, −0.013] for trans‐tibial amputation, and −0.055 [−0.080, −0.020], −0.075 [−0.090, −0.060] and −0.011 [−0.014, −0.007] for amputation below the ankle in people with type 1 diabetes, people with type 2 diabetes and people without diabetes, respectively. Conclusions Over recent decades, the incidence of amputation has decreased significantly in people with diabetes and in the general population without diabetes. What's new? Lower extremity amputation increases morbidity and risk of early death. Diabetes is one of the most important risk factors for lower extremity amputation. Over the last 20 years the incidence rates of amputation have declined significantly in people with and without diabetes. The results of this study support the idea that amputation is generally avoided at a higher rate than earlier.