Lower Extremity Amputation Rates in People With Diabetes Mellitus: A Retrospective Population Based Cohort Study in Zwolle Region, The Netherlands.

Lower extremity amputations are a major complication of diabetes mellitus (DM). In a previous Dutch study, the incident rate of major amputations was 89.2 per 100 000 person years. The primary aim of this study was to describe the lower extremity amputation rates in people with DM in the Zwolle region, where preventive and curative footcare is organised according to the guidelines of the International Working Group of the Diabetic Foot (IWGDF). The secondary aim was to evaluate outcomes and underlying characteristics of these people. This was a retrospective regional population based cohort study. Data from all people with DM treated in primary and secondary care, living in the region Zwolle were collected. All amputations in the period 2017 to 2019 were analysed. Comparisons were made between those with and without an amputation. In the analysis 5 915 people with DM were included, with a mean age of 67.8 (IQR 57.9, 75.9) years. Of those people, 47% were women and the median HbA1c was 53 (IQR 47, 62) mmol/mol. Over the three year study period 68 amputations were performed in 59 people: 46 minor, 22 major. This translated into an average annual crude amputation incidence rate of non-traumatic major and minor amputations of 41.5 and 86.9 per 100 000 person years among people with diabetes. Compared with those not undergoing amputations, those who underwent an amputation were more often men, older, mainly had T2DM, were treated in secondary care, had higher diastolic blood pressure, worse diabetic footcare profile, longer DM duration and higher HbA1c. At the end of the follow up, 111 people died: 96 (1.6%) without and 15 (25.4%) with amputations (p < .001). This retrospective study provides detailed insight into the rate of amputations in Dutch people with diabetes in the region Zwolle. Compared with previous Dutch estimates, these data suggest a considerable decrease in the major amputation incidence rate.

Rosien L ，van Dijk PR ，Oskam J ，Pierie MEN ，Groenier KH ，Gans ROB ，Bilo HJG ... -  《-》

A retrospective analysis of amputation rates in diabetic patients: can lower extremity amputations be further prevented?

Alvarsson A ，Sandgren B ，Wendel C ，Alvarsson M ，Brismar K ... -  《-》

Temporal trends in major, minor and recurrent lower extremity amputations in people with and without diabetes in Belgium from 2009 to 2018.

This study assessed temporal trends in the incidence of lower extremity amputations (LEA) in Belgium from 2009 to 2018, and subsequent secondary amputation rates. Nationwide data on LEA were collected. Sex- and age-adjusted annual incidence rates were calculated. Time trends were analysed in negative binomial models. The incidence of secondary interventions, defined as either any ipsilateral reamputation or any contralateral amputation, was studied with death as competing risk. 41 304 amputations were performed (13 247 major, 28 057 minor). In individuals with diabetes, the amputation rate (first amputation per patient per year) decreased from 143.6/100.000 person-years to 109.7 (IRR 0.97 per year, 95 %CI 0.96-0.98, p < 0.001). The incidence of major LEAs decreased from 56.2 to 30.7 (IRR 0.93, 95 %CI 0.91-0.94, p < 0.001); the incidence of minor amputations showed a non-significant declining trend in women (54.3 to 45.0/100 000 person years, IRR 0.97 per year, 95 %CI 0.96-0.99), while this remained stable in men with diabetes (149.2 to 135.3/100 000 person years, IRR 1.00 per year, 95 %CI 0.98-1.01). In individuals without diabetes, the incidence of major amputation didn't change significantly, whereas minor amputation incidence increased (8.0 to 10.6, IRR 1.04, 95 %CI 1.03-1.05, p < 0.001). In individuals with diabetes, one-year secondary intervention rates were high (31.3% after minor, 18.4% after major LEA); the incidence of secondary amputations didn't change. A significant decline in the incidence rate of major LEA was observed in people with diabetes. This decline was not accompanied by a significant rise in minor LEA. The incidence of secondary interventions remained stable.

Lauwers P ，Wouters K ，Vanoverloop J ，Avalosse H ，Hendriks J ，Nobels F ，Dirinck E ，Belgian Amputation Group ... -  《-》

Nationwide diabetes-related lower extremity amputation rates in secondary care treated patients with diabetes in the Netherlands (DUDE-7).

To estimate the annual amputation rate in all secondary care treated patients with diabetes in the Netherlands and specifically in patients known with diabetic retinopathy. A nationwide population-based retrospective cohort study was performed including the years 2007-2011. Data of patients were retrieved from reimbursement registries for hospital care from a nationwide insurance database including codes for diabetes, retinopathy and amputation. Traumatic amputations were excluded. The number of patients with secondary care treated diabetes increased from 132.499 to 137.049 over the years 2007-2011 in the Netherlands. The annual rate of non-traumatic lower-extremity amputations ranged from 4.32 to 5.28 amputations per 1.000 patients. For patients diagnosed with non-proliferative and (pre-) proliferative diabetic retinopathy, the mean amputation rates were 7.9 per 1.000 and 14.7 per 1.000, respectively. The Dutch annual incidence rates of non-traumatic lower extremity amputations in secondary care treated patients with diabetes is relatively low and remained stable over the years 2007 to 2011. The amputation rate in patients with retinopathy was substantially higher compared to patients without retinopathy.

Nijenhuis-Rosien L ，Hendriks SH ，Kleefstra N ，Bilo HJ ，Landman GW ... -  《-》

Reducing major lower extremity amputations after the introduction of a multidisciplinary team for the diabetic foot.

Rubio JA ，Aragón-Sánchez J ，Jiménez S ，Guadalix G ，Albarracín A ，Salido C ，Sanz-Moreno J ，Ruiz-Grande F ，Gil-Fournier N ，Álvarez J ... -  《-》