Decreasing incidence of major amputations in people with diabetes

Aims/hypothesis. To assess the results of the strategy used in avoiding major amputations in patients with diabetes mellitus. Methods. A retrospective study for the years 1981 to 1995 in a central district hospital in Copenhagen with a catchment area population of about 178,000. Results. There were 463 major leg amputations and the incidence decreased from 27.2 to 6.9/100,000 population (75 %). The decrease in patients with Type I (insulin-dependent) diabetes mellitus was from 10.0 to 4.1 (59 %) and in Type II (non-insulin-dependent) diabetes mellitus from 17.2 to 2.8/100,000 people (84 %). Analysis showed that the diabetic population remained constant despite a considerable fall in the number of older people. During the study period infra-popliteal arterial bypass was introduced for the treatment of critical lower limb ischaemia and in diabetic patients the number of bypasses increased from zero to 13/100,000 population, The total number of revascularisation procedures in people with diabetes increased from 2.6 to 19.2/ 100,000 population. Moreover, a multidisciplinary diabetic foot clinic was established. Conclusion/interpretation. A 75 % reduction in the incidence of major amputations coincided with a sevenfold increase in revascularization procedures and the establishment of a multidisciplinary diabetic foot clinic suggesting these measures are important in the prevention of diabetic leg amputations.