title: Decreasing incidence of major amputations in people with diabetes.
abstract: OBJECTIVE
  To assess the results of the strategy used in avoiding major amputations in patients with diabetes mellitus.
  
  
  METHODS
  A retrospective study for the years 1981 to 1995 in a central district hospital in Copenhagen with a catchment area population of about 178,000.
  
  
  RESULTS
  There were 463 major leg amputations and the incidence decreased from 27.2 to 6.9/100,000 population (75%). The decrease in patients with Type I (insulin-dependent) diabetes mellitus was from 10.0 to 4.1 (59%) and in Type II (non-insulin-dependent) diabetes mellitus from 17.2 to 2.8/100,000 people (84%). Analysis showed that the diabetic population remained constant despite a considerable fall in the number of older people. During the study period infra-popliteal arterial bypass was introduced for the treatment of critical lower limb ischaemia and in diabetic patients the number of bypasses increased from zero to 13/100,000 population. The total number of revascularisation procedures in people with diabetes increased from 2.6 to 19.2/100,000 population. Moreover, a multidisciplinary diabetic foot clinic was established.
  
  
  CONCLUSIONS
  A 75% reduction in the incidence of major amputations coincided with a sevenfold increase in revascularization procedures and the establishment of a multidisciplinary diabetic foot clinic suggesting these measures are important in the prevention of diabetic leg amputations.
authors.affiliation: Copenhagen Wound Healing Centre, Bispebjerg Hospital, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Holstein
authors.forename: N
authors.initials: N
authors.lastname: Ellitsgaard
authors.forename: B B
authors.initials: BB
authors.lastname: Olsen
authors.forename: V
authors.initials: V
authors.lastname: Ellitsgaard
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D003718:Denmark / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D017719:Diabetic Foot / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006767:Hospitals, District; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors