title: Nationwide diabetes-related lower extremity amputation rates in secondary care treated patients with diabetes in the Netherlands (DUDE-7).
abstract: OBJECTIVE
  To estimate the annual amputation rate in all secondary care treated patients with diabetes in the Netherlands and specifically in patients known with diabetic retinopathy.
  
  
  METHODS
  A nationwide population-based retrospective cohort study was performed including the years 2007-2011. Data of patients were retrieved from reimbursement registries for hospital care from a nationwide insurance database including codes for diabetes, retinopathy and amputation. Traumatic amputations were excluded.
  
  
  RESULTS
  The number of patients with secondary care treated diabetes increased from 132.499 to 137.049 over the years 2007-2011 in the Netherlands. The annual rate of non-traumatic lower-extremity amputations ranged from 4.32 to 5.28 amputations per 1.000 patients. For patients diagnosed with non-proliferative and (pre-) proliferative diabetic retinopathy, the mean amputation rates were 7.9 per 1.000 and 14.7 per 1.000, respectively.
  
  
  CONCLUSIONS
  The Dutch annual incidence rates of non-traumatic lower extremity amputations in secondary care treated patients with diabetes is relatively low and remained stable over the years 2007 to 2011. The amputation rate in patients with retinopathy was substantially higher compared to patients without retinopathy.
authors.affiliation: Diabetes Centre, Isala, Zwolle, the Netherlands; Dr Spanjaardweg 11, 8025 BT Zwolle, The Netherlands; Innofeet Foot Centre Nijenhuis, Zwolle, The Netherlands; Simon Stevinweg 13, 8013 NA Zwolle, the Netherlands. Electronic address: L.nijenhuis@isala.nl.
authors.forename: Leonie
authors.initials: L
authors.lastname: Nijenhuis-Rosien
authors.affiliation: Diabetes Centre, Isala, Zwolle, the Netherlands; Dr Spanjaardweg 11, 8025 BT Zwolle, The Netherlands.
authors.forename: Steven Hans
authors.initials: SH
authors.lastname: Hendriks
authors.affiliation: Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; Medical Research group, Langerhans, Dr Spanjaardweg 11, 8025 BT Zwolle, The Netherlands.
authors.forename: Nanne
authors.initials: N
authors.lastname: Kleefstra
authors.affiliation: Diabetes Centre, Isala, Zwolle, the Netherlands; Dr Spanjaardweg 11, 8025 BT Zwolle, The Netherlands; Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; Department of Internal Medicine, Isala, Zwolle, the Netherlands; Dr. van Heesweg 2, 8025 AB Zwolle, The Netherlands.
authors.forename: Hendricus Jozef Gerardus
authors.initials: HJ
authors.lastname: Bilo
authors.affiliation: Medical Research group, Langerhans, Dr Spanjaardweg 11, 8025 BT Zwolle, The Netherlands; Department of Internal Medicine, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands.
authors.forename: Gijs Wilhelmus Diederik
authors.initials: GW
authors.lastname: Landman
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003920:Diabetes Mellitus / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D017719:Diabetic Foot / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D003930:Diabetic Retinopathy / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement; D035002:Lower Extremity; D008297:Male; D055806:Microvessels / Q000503:physiopathology; D008875:Middle Aged; D009426:Netherlands; D058729:Peripheral Arterial Disease / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D012189:Retrospective Studies; D063127:Secondary Health Care; D012720:Severity of Illness Index
keywords: Amputation; Complications; Diabetes; Diabetic foot; Peripheral arterial disease; Retinopathy