title: Fewer major amputations among individuals with diabetes in Finland in 1997-2007: a population-based study.
abstract: OBJECTIVE
  Complications occur in diabetes despite rigorous efforts to control risk factors. Since 2000, the National Development Programme for the Prevention and Care of Diabetes has worked to halve the incidence of amputations in 10 years. Here we evaluate the impact of the efforts undertaken by analyzing the major amputations done in 1997-2007.
  
  
  METHODS
  All individuals with diabetes (n = 396,317) were identified from comprehensive national databases. Data on the first major amputations (n = 9,481) performed for diabetic and nondiabetic individuals were obtained from the National Hospital Discharge Register.
  
  
  RESULTS
  The relative risk for the first major amputation was 7.4 (95% CI 7.2-7.7) among the diabetic versus the nondiabetic population. The standardized incidence of the first major amputation decreased among the diabetic and nondiabetic populations (48.8 and 25.2% relative risk reduction, respectively) over 11 years, and the time from the registration of diabetes to the first major amputation was significantly longer, on average 1.2 years more. The cumulative five-year postamputation mortality among diabetic individuals was 78.7%.
  
  
  CONCLUSIONS
  In our nationwide diabetes database, the duration from the registration of diabetes to the first major amputation increased, and the incidence of major amputations decreased almost 50% in 11 years. Approximately half of this change was due to the increasing size of the diabetic population. The risk for major amputation is more than sevenfold that among the nondiabetic population. These results pose a continuous challenge to improve diabetes care.
authors.affiliation: THL (National Institute for Health and Welfare), Helsinki, Finland. tuija.ikonen@thl.fi
authors.forename: Tuija S
authors.initials: TS
authors.lastname: Ikonen
authors.forename: Reijo
authors.initials: R
authors.lastname: Sund
authors.forename: Maarit
authors.initials: M
authors.lastname: Venermo
authors.forename: Klas
authors.initials: K
authors.lastname: Winell
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
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