title: The contribution of non-insulin-dependent diabetes to lower-extremity amputation in the community.
abstract: BACKGROUND
  Despite the significant public health burden of lower-extremity amputations in diabetes mellitus, few data are available on the epidemiology of lower-extremity amputations in diabetes mellitus in the community setting.
  
  
  METHODS
  A retrospective incidence cohort study based in Rochester, Minn, was conducted.
  
  
  RESULTS
  Among the 2015 diabetic individuals free of lower-extremity amputation at the diagnosis of diabetes mellitus, 57 individuals underwent 79 lower-extremity amputations (incidence, 375 per 100,000 person-years; 95% confidence interval, 297 to 467). Among the 1826 patients with non-insulin-dependent diabetes mellitus, 52 underwent 73 lower-extremity amputations, and the subsequent incidence of lower-extremity amputation among these residents was 388 per 100,000 person-years (95% confidence interval, 304 to 487). Of the 137 insulin-dependent diabetic patients, four subsequently underwent five lower-extremity amputations (incidence, 283 per 100,000 person-years; 95% confidence interval, 92 to 659). Twenty-five years after the diagnosis of diabetes mellitus, the cumulative risk of one lower-extremity amputation was 11.2% in insulin-dependent diabetes mellitus and 11.0% in non-insulin-dependent diabetes mellitus. When compared with lower-extremity amputation rates for Rochester residents without diabetes, patients with non-insulin-dependent diabetes mellitus were nearly 400 times more likely to undergo an initial transphalangeal amputation (rate ratio, 378.8) and had almost a 12-fold increased risk of a below-knee amputation (rate ratio, 11.8). In this community, more than 60% of lower-extremity amputations were attributable to non-insulin-dependent diabetes mellitus.
  
  
  CONCLUSIONS
  These population-based data document the magnitude of the elevated risk of lower-extremity amputation among diabetic individuals. Efforts should be made to identify more precisely risk factors for amputation in diabetes and to intervene in the processes leading to amputation.
authors.affiliation: Section of General Medicine, Veterans Affairs Medical Center, Oregon Health Sciences University, Portland.
authors.forename: L L
authors.initials: LL
authors.lastname: Humphrey
authors.forename: P J
authors.initials: PJ
authors.lastname: Palumbo
authors.forename: M A
authors.initials: MA
authors.lastname: Butters
authors.forename: J W
authors.initials: JW
authors.lastname: Hallett
authors.forename: C P
authors.initials: CP
authors.lastname: Chu
authors.forename: W M
authors.initials: WM
authors.lastname: O'Fallon
authors.forename: D J
authors.initials: DJ
authors.lastname: Ballard
mesh_terms: D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D017719:Diabetic Foot / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D007866:Leg / Q000601:surgery*; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D016017:Odds Ratio; D012189:Retrospective Studies