Fewer major amputations among individuals with diabetes in Finland in 1997-2007: a population-based study.
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.
Ikonen
Tuija S
TS
THL (National Institute for Health and Welfare), Helsinki, Finland. tuija.ikonen@thl.fi
Sund
Reijo
R
Venermo
Maarit
M
Winell
Klas
K
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
Diabetes Care. 2008 Jan;31(1):99-101
17934144
Diabetes Care. 2009 Feb;32(2):275-80
19001192
Scand J Surg. 2006;95(3):185-9
17066615
Diabet Med. 2009 Aug;26(8):773-7
19709146
Eur J Vasc Endovasc Surg. 2006 Jul;32(1):66-70
16513375
Eur J Surg. 2002;168(12):724-9
15362584
South Med J. 2007 Aug;100(8):787-90
17713304
Curr Diab Rep. 2004 Dec;4(6):413-8
15539004
Diabetes Care. 2008 Mar;31(3):459-63
18071005
Diabetologia. 2000 Jul;43(7):844-7
10952455
Diabetes Care. 2008 Aug;31(8):1536-40
18443192
Exp Clin Endocrinol Diabetes. 2009 Oct;117(9):500-4
19629934
Diabetes Care. 2004 Aug;27(8):1892-6
15277413
Prosthet Orthot Int. 2007 Sep;31(3):277-86
17979013
Diabetes Care. 2007 Oct;30(10):2633-7
17644615
Diabetes Care. 2009 Feb;32(2):306-7
18984775
Diabetes Care. 2004 Jul;27(7):1598-604
15220234
Diabetes Care. 2004 May;27(5):1042-6
15111518
Eur J Vasc Endovasc Surg. 2004 Feb;27(2):193-200
14718903
Diabetes Care. 2006 Oct;29(10):2252-6
17003302