title: Amputations and foot ulcers in patients newly diagnosed with type 2 diabetes mellitus and observed for 19 years. The role of age, gender and co-morbidity.
abstract: OBJECTIVE
  To determine the prevalence of foot ulcers and the incidence of amputations in patients with Type 2 diabetes observed for 19 years after diagnosis. We investigated the role of gender, age and co-morbidities.
  
  
  METHODS
  From the Diabetes Care in General Practice study, 1381 patients were included and examined at diabetes diagnosis, at 6 years and at 14 years after diagnosis. Register-based follow-up was for 19 years. Foot ulcers and amputations were related to gender, age and co-morbidities by odds and hazard ratios from logistic and Cox regression models, respectively.
  
  
  RESULTS
  The incidence of any amputation and major amputation was 400 (95% CI 307-512) and 279 (95% CI 203-375) per 100,000 patient-years, respectively. At the three observation points, the foot ulcer prevalences were 2.76% (95% CI 1.89-3.63), 2.93% (95% CI 1.86-4.00) and 4.96% (95% CI 3.10-6.82). Multivariate analyses showed associations between foot ulcers and peripheral neuropathy, peripheral arterial disease, male gender, retinopathy and myocardial infarction. After multivariate adjustment, significant predictors (hazard ratio; 95% CI) of any amputation were peripheral neuropathy (hazard ratio 2.09; 95% CI 1.19-3.69), peripheral arterial disease (hazard ratio 3.43; 95% CI 1.65-7.12), microalbuminuria (hazard ratio 2.11; 95% CI 1.21-3.67), retinopathy (hazard ratio 6.42; 95% CI 2.59-15.90), impaired vision (hazard ratio 6.92; 95% CI 2.35-20.38) and male gender (hazard ratio 2.40; 95% CI 1.31-4.41). For women, the risk of amputation increased with age, but for men the risk was higher when diagnosed with diabetes at a younger age.
  
  
  CONCLUSIONS
  Despite improved treatment regimens, the incidence of amputations is still high in this population-based patient sample. Men diagnosed with diabetes before age 65 years and patients with diabetes-related co-morbidities are at particularly high risk of foot ulcers and amputations.
authors.affiliation: The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. christine.bruun@sund.ku.dk
authors.forename: C
authors.initials: C
authors.lastname: Bruun
authors.forename: V
authors.initials: V
authors.lastname: Siersma
authors.forename: A D
authors.initials: AD
authors.lastname: Guassora
authors.forename: P
authors.initials: P
authors.lastname: Holstein
authors.forename: N
authors.initials: N
authors.lastname: de Fine Olivarius
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000671:Amputation, Surgical; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000628:therapy; D017719:Diabetic Foot / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D003929:Diabetic Neuropathies / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D003930:Diabetic Retinopathy / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D015995:Prevalence; D012737:Sex Factors; D015599:Trauma Severity Indices