title: Foot ulceration and lower limb amputation in type 2 diabetic patients in dutch primary health care.
abstract: OBJECTIVE
  To determine the incidence of foot ulceration and lower limb amputation in type 2 diabetic patients in primary health care.
  
  
  METHODS
  Data on type 2 diabetes were collected by the Nijmegen Monitoring Project between 1993 and 1998 as part of a study of chronic diseases. The records of all patients recorded as having diabetic foot problems and those who died, moved to a nursing home, or were under specialist care were included. The annual incidence of foot ulceration was defined as the number of type 2 diabetic patients per patient-year who developed a new foot ulcer. Incidence of lower limb amputation was similarly defined. Additional information was collected on treatment of foot ulcers.
  
  
  RESULTS
  The study population of type 2 diabetic patients increased from 511 patient-years in 1993 to 665 in 1998. The annual incidence of foot ulceration varied between 1.2 and 3.0% (mean 2.1) per year; 25% of the patients had recurrent episodes. The annual incidence of lower limb amputation varied between 0.5 and 0.8% (mean 0.6). Ten of the 15 amputees died, and 12 of 52 (23%) patients with ulceration had a subsequent amputation or a previous history of amputation. In 35 of the 73 (48%) episodes of ulceration, only the family physician provided treatment. Patients with foot problems were older and had more cardiovascular disease, retinopathy, and absent peripheral pulses.
  
  
  CONCLUSIONS
  The incidence of foot ulceration and lower limb amputation in type 2 diabetes is low; nevertheless, recurrence rates of ulceration and risk of amputation are high, with high mortality.
authors.affiliation: Julius Centre for General Practice and Patient Oriented Research, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: Ilona Statius
authors.initials: IS
authors.lastname: Muller
authors.forename: Wim J C
authors.initials: WJ
authors.lastname: de Grauw
authors.forename: Willem H E M
authors.initials: WH
authors.lastname: van Gerwen
authors.forename: Marie Louise
authors.initials: ML
authors.lastname: Bartelink
authors.forename: Henk J M
authors.initials: HJ
authors.lastname: van Den Hoogen
authors.forename: Guy E H M
authors.initials: GE
authors.lastname: Rutten
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D017719:Diabetic Foot / Q000453:epidemiology*; D003937:Diagnosis, Differential; D005260:Female; D016523:Foot Ulcer / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012042:Registries