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Fewer adults with diabetes undergo lower-limb amputations, but remain at increased risk
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From 1996 to 2008, rates of lower-limb amputations among US adults with diabetes decreased by 65%. Nevertheless, in 2008, data from a study conducted by CDC researchers demonstrated that patients with diabetes are still much more likely to require amputation.
“Our results showed substantial decreases in amputation rates in the US diabetic population aged 40 years or older, with rates declining by 65% from 1996 to 2008 (from 11 to 4 per 1,000),” study researcher Nilka Ríos Burrows, MPH, told Endocrine Today. “However, the amputation rate in 2008 was still about eight times higher among people with diabetes compared with those without the disease, indicating a need for additional efforts to further reduce the excess risk for amputation among people with diabetes.”
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To evaluate trends in rates of hospitalization for nontraumatic lower-extremity amputation between adults with diabetes and those without the disease, Yanfeng Li, MD, MPH, Burrows and colleagues examined data from the National Hospital Discharge Survey on lower-limb amputation procedures and the National Health Interview Survey on diabetes prevalence from 1988 to 2008.
Although results revealed a sharp increase in diagnosed diabetes throughout the study period, the estimated number of diabetes-related lower-limb amputations decreased dramatically from 11.2 to 3.9 per 1,000 patients, with an annual percentage change of 8.6% (P<.01). In comparison, amputation rates among those without diabetes changed little, with researchers noting only a 0.7% annual percentage change (P>.05). Even so, the age adjusted amputation rate in 2008 for patients with diabetes was 3.9 vs. 0.5 per 1,000 for those without the disease, according to study data.
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The researchers also found that, among patients with diabetes, men had higher age-adjusted rates of leg and foot amputations in 2008 when compared with women (6 vs. 1.9 per 1,000 patients), and black patients had higher rates when compared with white patients (4.9 vs. 2.9 per 1,000 patients). Amputation rates were also highest among patients aged 75 years and older (6.2 per 1,000 patients) vs. other age groups.
Despite the encouraging data, Burrows said patients with diabetes must remain vigilant.
“People with diabetes need to check their feet daily for sores and injuries and also have their feet examined by a doctor at least once a year,” she said. “Further decreases in rates of amputations will require continued awareness of diabetes and its complications among patients and providers as well as comprehensive interventions to improve foot care and overall care for people with diabetes and reduce risk factors for amputation.”
To find out more, Burrows said patients should visit the CDC website: http://www.cdc.gov/features/diabetesfoothealth/.
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Disclosure: The researchers report no relevant financial disclosures.
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