Lower-Extremity Amputation in People With Diabetes: Epidemiology and Prevention

  1. Jonathon A Showstack, MPH
  1. Division of Diabetes Control, and the Training and Laboratory Program Office, Centers for Disease Control Atlanta Georgia Division of Research, Kaiser Permanente Medical Care Program Oakland Clinical Epidemiology Program, Department of Family and Community Medicine, Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
  1. Address correspondence and reprint requests to Diane Bild, MD, MPH, Division of Diabetes Control, Centers for Disease Control, 1600 Clifton Road, NE, Atlanta, CA 30333.

Abstract

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.

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