Diabetes and Non-diabetes Related Lower Extremity Amputation Incidence Before and After the Introduction of Better Organized Diabetes Foot Care. Continuous longitudinal monitoring using a standard method

doi:10.2337/dc07-1159

Diabetes and Non-diabetes Related Lower Extremity Amputation Incidence Before and After the Introduction of Better Organized Diabetes Foot Care. Continuous longitudinal monitoring using a standard method

Ronan J Canavan, MB, MRCP,
Nigel C Unwin, DM, FFPHM,
William F Kelly, MD, FRCP and
Vincent M Connolly, MD, FRCP

Diabetes Care Centre, James Cook University Hospital, Middlesborough, U.K.
Institute of Health and Society Newcastle University, Leech Building, The Medical School, Newcastle upon Tyne, U.K.
Diabetes Care Centre, James Cook University Hospital, Middlesborough, U.K.
Diabetes Care Centre, James Cook University Hospital, Middlesborough, U.K.

Abstract

Objective: There is a lack of continuous longitudinal population based lower extremity amputation (LEA) data in the UK. We present here accurate data on trends in diabetes related (DR)LEAs and non-DRLEAs in the South Tees area over a continuous 5 year period.

Research Design and Methods: All cases of LEA from 1^st July 1995 to 30^th June 2000 within the area were identified. Estimated ascertainment using capture-recapture analysis approached 100% for LEAs in the area. Data was collected longitudinally using the standard method of the Global Lower Extremity Amputation Study protocol.

Results: Over 5 years there were 454 LEAs (66.3% male) in the South Tees area, of which 223 were diabetes related (49.1%). Among persons with diabetes LEA rates went from 564.3 in the 1^st year to 176.0 per 100,000 persons with diabetes in the 5^th year. Over the same period non-DRLEAs increased from 12.3 to 22.8 per 100,000 persons without diabetes. The relative risk of a person with diabetes undergoing an LEA went from being 46 times that of a person without diabetes to 7.7 at the end of the 5 years. The biggest improvement in LEA incidence was seen in the reduction of repeat major DRLEAs.

Conclusion: Our data shows that in the South Tees area at a time when major non-DRLEA rates increased major DRLEA rates have fallen. These diverging trends mark a significant improvement in care for patients with diabetic foot disease as a result of better organized diabetes care.