Good News in Diabetes Care: Amputations Are Way Down Since 1990s

Want some good news? Improvements in diabetes care are credited with a huge drop in disease-related amputations since the mid-1990s, according to a study in Diabetologia, the journal of European Association for the Study of Diabetes.

The loss of lower limbs is one of the most serious threats of diabetes; this can happen if blood vessel damage over time becomes serious enough to disrupt the blood supply to the extremities. Feet are especially vulnerable; foot ulcers are a common complaint and cause of hospitalization among those with diabetes.

While the study took place in Denmark’s Funen region from 1996-2011, researchers say the results apply to other high-income countries around the world. The team from Odense University Hospital, Denmark, used data from the Danish National Diabetes Register, as well as mortality and population data, to identify amputations over that period.

Researchers found major reductions in diabetes-related amputations, both overall and of different types. Annual reductions in amputations below the ankle were 10%, while annual reductions in those below the knee were 15%. Annual reductions for those above the knee for patients with diabetes were 3%. Annual reductions in amputation rates unrelated to diabetes—caused by vascular diseases, for example—remained unchanged.

The team believes the improvements are the result of better drugs, increases in foot inspection, and improved self-care of foot ulcers. “Our study suggests that the reduction in amputation rates among diabetes patients most likely is due to improvements in the care of individuals with diabetes,” they write.

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

Still, those with diabetes remained more likely to have amputations than those without the disease: diabetes patients were 11 times more likely to have amputations below the ankle, 7 times more likely to have amputations below the knee, and 4 times more likely to have amputations above the knee.

To further reduce amputations, the authors suggest creating multidisciplinary diabetes clinics that can treat underlying micro- and macrovascular disease, in addition to foot ulcers.