title: Amputation rate and risk factors in type 2 patients with diabetic foot syndrome under real-life conditions in Germany.
abstract: OBJECTIVE
  To determine the risk of amputation and the influencing factors for amputation for patients with type 2 diabetes with diabetic foot syndrome.
  
  
  METHODS
  Longitudinal data from general practices in Germany (Disease Analyzer database, IMS Health) were analyzed. 3892 type 2 diabetes patients (mean age: 66.0 (SD: 10.9 years), 39.1% female) with a first-time diagnosis of diabetic foot syndrome between 01/200 and 12/2004 and at least 5 year follow-up documentation in the practices were included. The analyses of amputation-free survival were carried out using Kaplan-Meier curves and log-rank tests. A multivariate Cox regression model was fitted with the incident of diabetes-associated amputations as the dependent variable and adjusted for clinical and demographic characteristics.
  
  
  RESULTS
  The cumulative incidence of diabetes-associated lower limb amputations was 18.2%. Amputations are independently associated with higher age, male gender, higher HbA1c value and longer diabetes duration but also some other diabetes complications.
  
  
  CONCLUSIONS
  The diabetic foot syndrome can but must not lead to a lower limb amputation. Due to the great medical and economic burden on the health system caused by diabetic complications, early therapeutic intervention is essential for patients with diabetic foot syndrome.
authors.affiliation: Department of Diabetology, Clinical Center Traunstein, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Pscherer
authors.forename: Franz-Werner
authors.initials: FW
authors.lastname: Dippel
authors.forename: Silke
authors.initials: S
authors.lastname: Lauterbach
authors.forename: Karel
authors.initials: K
authors.lastname: Kostev
mesh_terms: D000367:Age Factors; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D015415:Biomarkers / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D017719:Diabetic Foot / Q000453:epidemiology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005858:Germany / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011320:Primary Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human