Reduction in Diabetic Amputations Over 11 Years in a Defined U.K. Population
Benefits of multidisciplinary team work and continuous prospective audit
- Singhan Krishnan, MRCP,
- Fiona Nash, RGN,
- Neil Baker, BSC,
- Duncan Fowler, MD and
- Gerry Rayman, MD
- Address correspondence and reprint requests to Gerry Rayman, MD, Ipswich Hospital, Diabetes Center, Heath Road, Ipswich, Suffolk IP4 5PD, U.K. E-mail: gerry.rayman{at}ipswichhospital.nhs.uk
Abstract
OBJECTIVE—To assess changes in diabetic lower-extremity amputation rates in a defined relatively static population over an 11-year period following the introduction of a multidisciplinary foot team.
RESEARCH DESIGN AND METHODS—All diabetic patients with foot problems admitted to Ipswich Hospital, a large district general hospital, were identified by twice-weekly surveillance of all relevant in-patient areas and outcomes including amputations recorded.
RESULTS—The incidence of major amputations fell 62%, from 7.4 to 2.8 per 100,000 of the general population. Total amputation rates also decreased (40.3%) but to a lesser extent due to a small increase in minor amputations. Expressed as incidence per 10,000 people with diabetes, total amputations fell 70%, from 53.2 to 16.0, and major amputations fell 82%, from 36.4 to 6.7.
CONCLUSIONS—Significant reductions in total and major amputation rates occurred over the 11-year period following improvements in foot care services including multidisciplinary team work.
Footnotes
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Published ahead of print at http://care.diabetesjournals.org on 12 October 2007. DOI: 10.2337/dc07-1178.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
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- Accepted October 10, 2007.
- Received June 21, 2007.
- DIABETES CARE
