Trends in lower-extremity amputations in people with and without diabetes in Spain, 2001-2008

Abstract

Objective: To examine trends in nontraumatic lower-extremity amputations (LEAs) over an 8-year period in patients with and without diabetes in Spain.

Research design and methods: We identified all patients who underwent an LEA using national hospital discharge data. Discharges were grouped by diabetes status: type 1 diabetes, type 2 diabetes, and no diabetes. The incidence of discharges attributed to amputations were calculated overall and stratified by diabetes status and year. We calculated length of stay and in-hospital fatality stratified by diabetes status and type of LEA.

Results: From 2001 to 2008, 46,536 minor LEAs and 43,528 major LEAs were performed. In patients with type 1 diabetes, the incidence of minor and major amputations decreased significantly from 2001 to 2008 (0.88-0.43 per 100,000 inhabitants and 0.59-0.22 per 100,000 inhabitants, respectively). In patients with type 2 diabetes, the incidence of minor and major LEAs increased significantly (9.23-10.9 per 100,000 inhabitants and 7.12-7.47 per 100,000 inhabitants). Hospital stay was similar among type 1 diabetic and type 2 diabetic subjects, according to the type of LEA. Only in-hospital mortality for minor LEAs among type 1 diabetic subjects decreased significantly (4.0% in 2001 vs. 1.6% in 2008).

Conclusions: Our national data show a decrease in the incidence of major and minor LEAs in patients with type 1 diabetes and an increase among patients with type 2 diabetes. Further improvement is necessary in the preventive care and early treatment of patients with diabetes. The management of foot lesions, especially among type 2 diabetic patients, is particularly urgent.

Figure 1

Changes in minor and major LEA incidence rates in patients with type 1 diabetes expressed per 100,000 inhabitants (A) and in patients with type 2 diabetes expressed per 100,000 inhabitants (B) (Spain, 2001–2008). *P < 0.05 (Poisson regression analysis). Population data were obtained from the Spanish National Institute of Statistics (9). The estimated total population was 40,964,000 in 2001; 41,663,000 in 2002; 42,345,000 in 2003; 43,038,000 in 2004; 43,758,000 in 2005; 44,474,000 in 2006; 45,283,000 in 2007; and 45,828,000 in 2008.