title: Substantial reduction in the number of amputations among patients with diabetes: a cohort study over 16 years.
abstract: OBJECTIVE
  The aim of this study was to describe the trends in rates of amputation among individuals with and without diabetes.
  
  
  METHODS
  We studied amputation rates in the County of Funen (approximately 0.5 million residents) during the period 1996-2011. Amputations were identified from the hospital administrative system, diabetes status by linkage with the Danish National Diabetes Register, and mortality and population data by extraction from Statistics Denmark. Amputation rates were analysed using proportional hazard models. We analysed the incidence of the first amputation at each level as well as the incidence of further amputations, subdivided by level of amputation.
  
  
  RESULTS
  During the period 1996-2011, a total of 2,832 amputations were performed, of which 1,285 were among patients with diabetes and 1,547 among individuals without diabetes. Relative to persons without diabetes, patients with diabetes had an HR for below-ankle amputations (BAAs) of 14.7 for men and 7.5 for women, and for from-ankle-to-knee amputations (BKAs) of 7.6 and 8.4 for men and women, respectively. For above-knee amputations (AKAs) the numbers were 4.0 for men and 3.7 for women. We found an annual reduction in BAA rates among patients with diabetes of 9.8%, and the annual reduction in BKA for patients with diabetes was 15.1%.
  
  
  CONCLUSIONS
  The amputation rate in patients with diabetes is still several-fold higher than in persons without diabetes, but the improvements in diabetes care in recent years have resulted in a steady decline in amputation rates among patients with diabetes from this Danish cohort.
authors.affiliation: Department of Medical Endocrinology, Odense University Hospital Denmark, Sdr. Boulevard 29, 5000, Odense C, Denmark. bsr@rsyd.dk.
authors.forename: Benjamin S B
authors.identifier: http://orcid.org/0000-0002-7357-0755
authors.initials: BSB
authors.lastname: Rasmussen
authors.affiliation: Department of Medical Endocrinology, Odense University Hospital Denmark, Sdr. Boulevard 29, 5000, Odense C, Denmark.
authors.forename: Knud B
authors.initials: KB
authors.lastname: Yderstraede
authors.affiliation: Clinical Epidemiology, Steno Diabetes Centre, Gentofte, Denmark.
authors.forename: Bendix
authors.initials: B
authors.lastname: Carstensen
authors.affiliation: Department of Orthopaedic Surgery, Odense University Hospital, Odense, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Skov
authors.affiliation: Department of Medical Endocrinology, Odense University Hospital Denmark, Sdr. Boulevard 29, 5000, Odense C, Denmark.
authors.forename: Henning
authors.initials: H
authors.lastname: Beck-Nielsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003718:Denmark; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D017719:Diabetic Foot / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012737:Sex Factors; D055815:Young Adult
keywords: Amputation; Diabetes; Diabetic patients