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. 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

Heiner Claessen  1   2   3 , Herve Avalosse  4   5 , Joeri Guillaume  4   6 , Maria Narres  7   8   9 , Tatjana Kvitkina  7   8   9 , Werner Arend  8 , Stephan Morbach  8   10 , Patrick Lauwers  11   12 , Frank Nobels  6   13 , Jacques Boly  5 , Chris Van Hul  14 , Kris Doggen  15 , Isabelle Dumont  16   17 , Patricia Felix  16   18 , Kristien Van Acker  19 , Andrea Icks  7   8
Affiliations

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

Heiner Claessen et al. Diabetologia. 2018 Sep.

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.

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Conflict of interest statement

The authors declare that there is no duality of interest associated with this manuscript.

Figures

Fig. 1
Fig. 1
Time trend of age- and sex-standardised major amputation rate. Solid lines, people with diabetes; dashed lines, people without diabetes; circles, men and women; squares, men; triangles, women. *p < 0.05 for time trend (Poisson model)
Fig. 2
Fig. 2
Time trend of age- and sex-standardised major above-the-knee amputation rate. Solid lines, people with diabetes; dashed lines, people without diabetes; circles, men and women; squares, men; triangles, women. *p < 0.05 for time trend (Poisson model)
Fig. 3
Fig. 3
Time trend of age- and sex-standardised major below-the-knee amputation rate. Solid lines, people with diabetes; dashed lines, people without diabetes; circles, men and women; squares, men; triangles, women. *p < 0.05 for time trend (Poisson model)
Fig. 4
Fig. 4
Time trend of age- and sex-standardised minor amputation rate. Solid lines, people with diabetes; dashed lines, people without diabetes; circles, men and women; squares, men; triangles, women. *p < 0.05 for time trend (Poisson model)
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