title: Decrease in (Major) Amputations in Diabetics: A Secondary Data Analysis by AOK Rheinland/Hamburg.
abstract: OBJECTIVE
  In two German regions with 11.1 million inhabitants, 6 networks for specialized treatment of DFS were implemented until 2008. Data provided for accounting purposes was analysed in order to determine changes in the rate of diabetics requiring amputations in the years before and after the implementation.
  
  
  METHODS
  Data covering 2.9 million people insured by the largest insurance company between 2007 and 2013 was analysed by the use of log-linear Poisson regression adjusted for age, gender and region.
  
  
  RESULTS
  The rate of diabetics needing major amputations fell significantly by 9.5% per year (p < 0.0001) from 217 to 126 of 100,000 patients per year. The rate of diabetics needing amputations of any kind fell from 504 to 419 of 100,000 patients per year (p = 0.0038).
  
  
  CONCLUSIONS
  The networks integrate health care providers in an organised system of shared care. They educate members of the medical community and the general public. At the same time, a more general disease management program for people with diabetes was implemented, which may also have contributed to this decrease. At the end of the observation period, the rate of diabetics requiring amputations was still high. For this reason, further expansion of organised specialized care is urgently needed.
authors.affiliation: AOK Rheinland/Hamburg, Die Gesundheitskasse, Unternehmensbereich Ambulante Versorgung, Geschäftsbereich Selektivverträge, Kasernenstrasse 61, 40213 Düsseldorf, Germany.
authors.forename: Melanie
authors.initials: M
authors.lastname: May
authors.affiliation: AOK Rheinland/Hamburg, Die Gesundheitskasse, Unternehmensbereich M-RSA/Finanzen/Controlling, Geschäftsbereich Controlling, Kasernenstrasse 61, 40213 Düsseldorf, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Hahn
authors.affiliation: AOK Rheinland/Hamburg, Die Gesundheitskasse, Unternehmensbereich Ambulante Versorgung, Geschäftsbereich Selektivverträge, Kasernenstrasse 61, 40213 Düsseldorf, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Tonn
authors.affiliation: Chirurgische Praxis am Bayenthalgürtel, Bayenthalgürtel 45, 50968 Köln, Germany; Ltd. Arzt Abteilung, Wundchirurgie St. Vinzenz Hospital Köln, Merheimer Strasse 221, 50733 Köln, Germany.
authors.forename: Gerald
authors.initials: G
authors.lastname: Engels
authors.affiliation: Centrum für Diabetologie, Endoskopie und Wundheilung, Merheimer Strasse 217, 50733 Köln, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Hochlenert
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D003625:Data Collection; D003695:Delivery of Health Care; D048909:Diabetes Complications / Q000453:epidemiology* / Q000517:prevention & control; D017719:Diabetic Foot / Q000453:epidemiology*; D005260:Female; D005858:Germany; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D015995:Prevalence; D012044:Regression Analysis