Diabetes and Lower-Limb Amputations in the Community: A retrospective cohort study

Andrew D Morris; Ritchie McAlpine; Douglas Steinke; Douglas IR Boyle; Abdul-Rahim Ebrahim; Naveen Vasudev; Colin PU Stewart; Roland T Jung; Graham P Leese; Thomas M MacDonald; Ray W Newton; For the DARTS/MEMO Collaboration

doi:10.2337/diacare.21.5.738

Original Articles

Diabetes and Lower-Limb Amputations in the Community: A retrospective cohort study

Andrew D Morris, MD ,
Ritchie McAlpine, BSC,
Douglas Steinke, BSC,
Douglas IR Boyle, BSC,
Abdul-Rahim Ebrahim,
Naveen Vasudev,
Colin PU Stewart, MD,
Roland T Jung, MD,
Graham P Leese, MD,
Thomas M MacDonald, MD,
Ray W Newton, FRCP and
For the DARTS/MEMO Collaboration

University Department of Medicine, Ninewells Hospital and Medical School Dundee, Scotland, U.K.
Diabetes Centre, Ninewells Hospital and Medical School Dundee, Scotland, U.K.
Medicines Monitoring Unit, Ninewells Hospital and Medical School Dundee, Scotland, U.K.
Dundee Limb Fitting Centre, Ninewells Hospital and Medical School Dundee, Scotland, U.K.

Address correspondence and reprint requests to Dr. Andrew D Morris, University Department of Medicine, Ninewells Hospital and Medical School, Dundee, DD1 9SY, U.K. E-mail: amorris{at}clinpharm.dundee.ac.uk.

Diabetes Care 1998 May; 21(5): 738-743. https://doi.org/10.2337/diacare.21.5.738

Abstract

OBJECTIVE There are few U.K. data on the incidence rates of amputation in diabetic subjects compared with the nondiabetic population.

RESEARCH DESIGN AND METHODS We performed a historical cohort study of first lower-extremity amputations based in Tayside, Scotland (population 364,880) from 1 January 1993 to 31 December 1994. The Diabetes Audit and Research in Tayside Scotland (DARTS) database was used to identify a prevalence cohort of 7,079 diabetic patients on 1 January 1993. We estimated age-specific and standardized incidence rates of lower-limb amputations in the diabetic and nondiabetic cohorts. Results were compared with a previous study that evaluated lower-extremity amputations in diabetic patients in Tayside in 1980–1982.

RESULTS There were 221 subjects who underwent a total of 258 nontraumatic amputations. Of the 221 subjects, 60 (27%) patients were diabetic (93% NIDDM), and 63% were first amputations. The median duration of diabetes was 6 years (range: newly diagnosed to 41 years). Nonhealing ulceration (31%) and gangrene (29%) were the two main indications for amputation in the diabetic subjects. Of the 161 nondiabetic subjects, 140 (80%) underwent first amputations. The adjusted incidences in the diabetic and nondiabetic groups were 248 and 20 per 100,000 person-years, respectively. Tayside patients with diabetes thus had a 12.3-fold risk of an amputation compared with nondiabetic residents (95% Cl 8.6–17.5). The estimated proportion of diabetic patients in the population rose from 0.81% in 1980–1982 to 1.94% in 1993–1994, whereas the absolute rate of amputation in diabetic subjects was unchanged from that in 1980–1982.

CONCLUSIONS These population-based U.K. amputation data are similar to amputation rates in the U.S. Amputation rates appear to have decreased significantly since 1980–1982. The impact of diabetes education and prevention programs that target the processes leading to amputation can now be evaluated.