Foot ulceration and lower limb amputation in type 2 diabetic patients in Dutch primary health care

OBJECTIVE - To determine the incidence of foot ulceration and lower limb amputation Ill type 2 diabetic patients in primary health care. RESEARCH DESIGN AND METHODS - Data on type 2 diabetes were collected by the Nijmegen Monitoring Project between 1993 and 1998 as part of a study of chronic diseases. The record of all patients recorded as having diabetic foot problems and those who died. moved to a nursing home, or ere under specialist care were included. The annual incidence of foot ulceration was defined as the number of type 2 diabetic patients per patient-year who developed a ne foot ulcer. Incidence of lower limb amputation was similarly defined. Additional information was collected on treatment of foot ulcers. RESULTS - The study population of type 2 diabetic patients increased from 511 patient-years s in 1993 to 665 in 1998. The annual incidence of foot ulceration varied between 1.2 and 3.0% (mean 2.1) per year: 25% of the patients had recurrent episode. The annual incidence: Of lower limb amputation varied between 0.5 and 0.8% (mean 0.6). Ten of the 15 amputees died, and 12 of 52 (23%) patients with ulceration had a subsequent amputation or a previous history of amputation. In 35 of the 73 (48%) episodes of ulceration, only the family physician provided treatment. Patients with foot problems were older and head more cardiovascular disease retinopathy, and absent peripheral pulses. CONCLUSIONS - The incidence of foot ulceration and lower limb amputation in type 2 diabetes is low; nevertheless, recurrence rates of ulceration and risk of amputation are high, with high mortality.