Diabetes- and nondiabetes-related lower extremity amputation incidence before and after the introduction of better organized diabetes foot care: continuous longitudinal monitoring using a standard method.
OBJECTIVE
There is a lack of continuous longitudinal population-based data on lower extremity amputation (LEA) in the U.K. We present here accurate data on trends in diabetes-related (DR) LEAs and non-DRLEAs in the South Tees area over a continuous 5-year period.


METHODS
All cases of LEA from 1 July 1995 to 30 June 2000 within the area were identified. Estimated ascertainment using capture-recapture analysis approached 100% for LEAs in the area. Data were collected longitudinally using the standard method of the Global Lower Extremity Amputation Study protocol.


RESULTS
Over 5 years there were 454 LEAs (66.3% men) in the South Tees area, of which 223 were diabetes related (49.1%). Among individuals with diabetes, LEA rates went from 564.3 in the first year to 176.0 of 100,000 persons with diabetes in the fifth year. Over the same period, non-DRLEAs increased from 12.3 to 22.8 of 100,000 persons without diabetes. The relative risk of a person with diabetes undergoing an LEA went from being 46 times that of a person without diabetes to 7.7 at the end of the 5 years. The biggest improvement in LEA incidence was seen in the reduction of repeat major DRLEAs.


CONCLUSIONS
Our data show that in the South Tees area at a time when major non-DRLEA rates increased, major DRLEA rates have fallen. These diverging trends mark a significant improvement in care for patients with diabetic foot disease as a result of better organized diabetes care.
Canavan
Ronan J
RJ
Diabetes Care Centre, James Cook University Hospital, Middlesborough, UK. ronan.canavan@hse.ie
Unwin
Nigel C
NC
Kelly
William F
WF
Connolly
Vincent M
VM
D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D048909:Diabetes Complications / Q000453:epidemiology / Q000517:prevention & control; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000517:prevention & control; D017719:Diabetic Foot / Q000453:epidemiology / Q000517:prevention & control / Q000601:surgery*; D015994:Incidence; D008137:Longitudinal Studies; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology