Study reports reduction in diabetes-related amputations since the mid-1990s

Diabetes-related amputations have significantly declined since the mid-1990s, thanks to improvements in diabetes care over this period, a new study reveals.

According to researchers at Odense University Hospital Denmark, below-ankle amputation rates among diabetes patients were reduced to 10 percent, while below-knee amputation rates for patients with diabetes decreased by 15 percent. For above-knee amputations, the annual rate of reduction for those with diabetes was around three percent and considered not statistically significant.

Amputations of the lower limbs are one of the most serious and disabling complications of diabetes. It has become necessary when the nerve and blood vessel damage caused by the condition affects the blood supply to the lower limbs, especially the feet. Serious problems with the feet, including ulceration, are a frequent reason for hospitalisation amongst patients who have diabetes.

The new study, published in Diabetologia, analysed amputation rates in the Funen region of Denmark during the period 1996 to 2011. Amputations were identified from the administrative system, diabetes status by linkage with the Danish National Diabetes Register, and mortality and population data were extracted from Statistics Denmark and the Civil Registration System.

During the period covered in the research, more than 2,800 amputations were performed, of which over 1,200 are done among patients with diabetes, while the rest are unrelated to the condition. The team found that amputation rates unrelated to diabetes remained unchanged over this period. However, despite the reductions in amputation rates for people with diabetes, they remained far more likely to have an amputation than those without diabetes.

The authors believe that better care related to diabetes and its complications, such as improved drugs and inspection and self-care of foot ulcers, are the central cause of the reduced amputation rates.

The introduction of vascular surgery and improved surgical techniques cannot explain their findings, since these procedures are applied equally in individuals with and without diabetes, the team says. “The findings in individuals with diabetes can therefore only be explained by improved diabetes care, namely improved metabolic control through drugs or lifestyle, or changes in how care is delivered, including better screening - we believe it to be both,” they explain.

While the reduction of amputations among diabetics is encouraging, the condition still poses a great challenge to improve care, the researchers note. To reduce the amputation rate further, the authors suggest a focus on establishing multidisciplinary diabetic clinics highly specialised in the diagnosis and treatment of the underlying macro- and microvascular diseases.

Around 70 Australians a week are having feet amputated as a result of preventable diabetes-related complications, according to Diabetes Queensland. According to the group’s CEO, Michelle Trute, a number of amputations could have been prevented with effective diabetes management that can be as simple as a regular foot checks. The group is pushing for stronger awareness among diabetics, to help manage their condition and avoid life-altering complications such as limb amputation and blindness.

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