Advances In Diabetes Care Lessen Lower Limb Amputations, But Diabetics Are Still At Risk

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Diabetes-related amputations are on the decline, but diabetics are still at greater risk. Pedro Ribeiro Simões, CC BY 2.0

It’s a tragic, if familiar, medical trope: the ailing diabetes patient whose condition has deteriorated to the point of them needing to have their lower extremities amputated.

According to new research published Sunday in Diabetologia, however, that trope is steadily becoming an outdated one. The Danish study authors analyzed the number of lower-limb amputations performed in a island region of Denmark from 1996 to 2011, finding that the amputation rate has decreased annually from 3 to 15 percent, depending on the type. Moreover, because the amputation rate for non-diabetics haven’t substantially changed in that same timeframe, the researchers are confident that the decrease reflects an overall improvement in diabetes care.

“The reduction in amputations among diabetic individuals is encouraging,” the authors wrote. “The results presented here indicate that it is beneficial to adopt a multidisciplinary approached optimised for screening and treating complications linked to diabetes. It is also encouraging that the overall amputation rate is declining in most parts of the world.”

Because Denmark is a country that allows for the relatively easy examination of medical records, due to their linked health registers, the researchers were able to collect extensive information on virtually every diagnosis of diabetes as well as every type of amputation performed in the island of Funen — with an average population of 5 million — during their study period. For the purposes of this research, they divided the amputations seen into three main types: those conducted below the ankle (supposedly minor amputations), those below the knee, and those above the knee.

In total, there were 2,832 amputations, of which 1,285 occurred in people with diabetes and 1,547 in people without. The rate of diabetes-related below-ankle amputations decreased 10 percent annually over the 16 years observed, whereas it was less than 1 percent for non-diabetic amputations. Breaking it further down, the annual decline for below-knee amputations was 15 percent for people with diabetes, and 2 percent for people without; and less than 3 percent for above-knee amputations in both groups. With respect to gender, men had a higher amputation rate.

“The introduction of vascular surgery, improved surgical techniques and empirically based antibiotic regimens cannot explain our findings, since these procedures are applied equally in individuals with and without diabetes,” the authors explained. “The findings in individuals with diabetes can therefore only be explained by improved diabetes care, for example, improved metabolic control or changes in organisation; we believe it to be due to both.”

Noting that their findings validate and agree with previous research on declining amputation rates elsewhere in the world, the researchers nonetheless remind us that people with diabetes are still at disproportionate risk of succumbing to amputations. As one example, they found that diabetics are 10 times more likely to have a below-ankle amputation performed than non-diabetics. This increased risk is tied to the poor blood circulation and nerve damage that often occurs as a result of diabetes, which can then lead to slow-healing diabetic foot ulcers.

Because of that, the researchers advocate a continued focus on improving and streamlining diabetes care, possibly by following the example set by Funen. “This includes regular foot inspection, better self-care and the establishment of specialised wound clinics in the uptake area consisting of a multidisciplinary wound care team,” they wrote. “Evidence is pointing towards better wound healing using this approach.”

Source: Rasmussen B, Yderstraede K, Cartensen B. Substantial reduction in the number of amputations among patients with diabetes: a cohort study over 16 years. Diabetologia. 2015.  

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