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Diabetologia. 2018 Sep;61(9):1966-1977. doi: 10.1007/s00125-018-4655-6. Epub 2018 Jun 16.

Decreasing rates of major lower-extremity amputation in people with diabetes but not in those without: a nationwide study in Belgium.

Author information

1
Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany. heiner.claessen@ddz.uni-duesseldorf.de.
2
Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. heiner.claessen@ddz.uni-duesseldorf.de.
3
German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany. heiner.claessen@ddz.uni-duesseldorf.de.
4
IMA/AIM (InterMutualistisch Agentschap/Agence Intermutualiste), Brussels, Belgium.
5
Landsbond der Christelijke Mutualiteiten/Alliance Nationale des Mutualités Chrétiennes, Brussels, Belgium.
6
Nationaal Verbond der Socialistische Mutualiteiten/Union Nationale des Mutualités Socialistes, Brussels, Belgium.
7
Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
8
Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
9
German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
10
Department of Diabetes and Angiology, Marienkrankenhaus, Soest, Germany.
11
Diabetes Liga, Ghent, Belgium.
12
Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium.
13
Department of Endocrinology, Onze Lieve Vrouw Ziekenhuis Aalst, Aalst, Belgium.
14
Landsbond van Onafhankelijke Ziekenfondsen/Union des Mutualités Libres, Anderlecht, Belgium.
15
Scientific Institute of Public Health, Brussels, Belgium.
16
Association Belge du Diabète, Brussels, Belgium.
17
Centre Multidisciplinaire du Pied Diabetique, Ransart, Belgium.
18
Department of Endocrinology, CHR de la Citadelle, Liège, Belgium.
19
D-Foot International (International Working Group on the Diabetic Foot- Implementation), Department of Diabetology and Endocrinology, CSF, Chimay, Belgium.

Abstract

AIMS/HYPOTHESIS:

The reduction of major lower-extremity amputations (LEAs) is one of the main goals in diabetes care. Our aim was to estimate annual LEA rates in individuals with and without diabetes in Belgium, and corresponding time trends.

METHODS:

Data for 2009-2013 were provided by the Belgian national health insurance funds, covering more than 99% of the Belgian population (about 11 million people). We estimated the age-sex standardised annual amputation rate (first per year) in the populations with and without diabetes for major and minor LEAs, and the corresponding relative risks. To test for time trends, Poisson regression models were fitted.

RESULTS:

A total of 5438 individuals (52.1% with diabetes) underwent a major LEA, 2884 people with above- and 3070 with below-the-knee major amputations. A significant decline in the major amputation rate was observed in people with diabetes (2009: 42.3; 2013: 29.9 per 100,000 person-years, 8% annual reduction, p < 0.001), which was particularly evident for major amputations above the knee. The annual major amputation rate remained stable in individuals without diabetes (2009: 6.1 per 100,000 person-years; 2013: 6.0 per 100,000 person-years, p = 0.324) and thus the relative risk reduced from 6.9 to 5.0 (p < 0.001). A significant but weaker decrease was observed for minor amputation in individuals with and without diabetes (5% and 3% annual reduction, respectively, p < 0.001).

CONCLUSIONS/INTERPRETATION:

In this nationwide study, the risk of undergoing a major LEA in Belgium gradually declined for individuals with diabetes between 2009 and 2013. However, continued efforts should be made to further reduce the number of unnecessary amputations.

KEYWORDS:

Amputation rate; Diabetes; Major lower-extremity amputation; Minor lower-extremity amputation; National health insurance funds

PMID:
29909501
PMCID:
PMC6096627
DOI:
10.1007/s00125-018-4655-6
[Indexed for MEDLINE]
Free PMC Article

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