title: Trends in lower-extremity amputations in people with and without diabetes in Spain, 2001-2008.
abstract: OBJECTIVE
  To examine trends in nontraumatic lower-extremity amputations (LEAs) over an 8-year period in patients with and without diabetes in Spain.
  
  
  METHODS
  We identified all patients who underwent an LEA using national hospital discharge data. Discharges were grouped by diabetes status: type 1 diabetes, type 2 diabetes, and no diabetes. The incidence of discharges attributed to amputations were calculated overall and stratified by diabetes status and year. We calculated length of stay and in-hospital fatality stratified by diabetes status and type of LEA.
  
  
  RESULTS
  From 2001 to 2008, 46,536 minor LEAs and 43,528 major LEAs were performed. In patients with type 1 diabetes, the incidence of minor and major amputations decreased significantly from 2001 to 2008 (0.88-0.43 per 100,000 inhabitants and 0.59-0.22 per 100,000 inhabitants, respectively). In patients with type 2 diabetes, the incidence of minor and major LEAs increased significantly (9.23-10.9 per 100,000 inhabitants and 7.12-7.47 per 100,000 inhabitants). Hospital stay was similar among type 1 diabetic and type 2 diabetic subjects, according to the type of LEA. Only in-hospital mortality for minor LEAs among type 1 diabetic subjects decreased significantly (4.0% in 2001 vs. 1.6% in 2008).
  
  
  CONCLUSIONS
  Our national data show a decrease in the incidence of major and minor LEAs in patients with type 1 diabetes and an increase among patients with type 2 diabetes. Further improvement is necessary in the preventive care and early treatment of patients with diabetes. The management of foot lesions, especially among type 2 diabetic patients, is particularly urgent.
authors: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain. ana.lopez@urjc.es
authors: Ana
authors: A
authors: López-de-Andrés
authors: María A
authors: MA
authors: Martínez-Huedo
authors: Pilar
authors: P
authors: Carrasco-Garrido
authors: Valentin
authors: V
authors: Hernández-Barrera
authors: Angel
authors: A
authors: Gil-de-Miguel
authors: Rodrigo
authors: R
authors: Jiménez-García
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