The contribution of non-insulin-dependent diabetes to lower-extremity amputation in the community

Linda Humphrey, Pasquale J. Palumbo, Matthew A. Butters, John W. Hallett, Chu P. Chu, W. Michael O'Fallon, David J. Ballard

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Abstract

Background: Despite the significant public health burden of lower-extremity amputations in diabetes mellitus, few data are available on the epidemiology of lowerextremity amputations in diabetes mellitus in the community setting. Methods: A retrospective incidence cohort study based in Rochester, Minn, was conducted. Results: Among the 2015 diabetic individuals free of lowerextremity amputation at the diagnosis of diabetes mellitus, 57 individuals underwent 79 lower-extremity amputations (incidence, 375 per 100 000 person-years; 95% confidence interval, 297 to 467). Among the 1826 patients with non-insulin-dependent diabetes mellitus, 52 underwent 73 lower-extremity amputations, and the subsequent incidence of lower-extremity amputation among these residents was 388 per 100 000 person-years (95% confidence interval, 304 to 487). Of the 137 insulin-dependent diabetic patients, four subsequently underwent five lowerextremity amputations (incidence, 283 per 100 000 personyears; 95% confidence interval, 92 to 659). Twenty-five years after the diagnosis of diabetes mellitus, the cumulative risk of one lower-extremity amputation was 11.2% in insulin-dependent diabetes mellitus and 11.0% in noninsulin-dependent diabetes mellitus. When compared with lower-extremity amputation rates for Rochester residents without diabetes, patients with non-insulin-dependent diabetes mellitus were nearly 400 times more likely to undergo an initial transphalangeal amputation (rate ratio, 378.8) and had almost a 12-fold increased risk of a belowknee amputation (rate ratio, 11.8). In this community, more than 60% of lower-extremity amputations were attributable to non-insulin-dependent diabetes mellitus. Conclusions: These population-based data document the magnitude of the elevated risk of lower-extremity amputation among diabetic individuals. Efforts should be made to identify more precisely risk factors for amputation in diabetes and to intervene in the processes leading to amputation.

Original languageEnglish (US)
Pages (from-to)885-892
Number of pages8
JournalMolecular and Cellular Biology
Volume15
Issue number6
StatePublished - Apr 25 1994

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Amputation
Lower Extremity
Type 2 Diabetes Mellitus
Diabetes Mellitus
Confidence Intervals
Incidence
Cohort Studies
Type 1 Diabetes Mellitus
Epidemiology
Public Health

ASJC Scopus subject areas

  • Cell Biology
  • Genetics
  • Molecular Biology

Cite this

Humphrey, L., Palumbo, P. J., Butters, M. A., Hallett, J. W., Chu, C. P., O'Fallon, W. M., & Ballard, D. J. (1994). The contribution of non-insulin-dependent diabetes to lower-extremity amputation in the community. Molecular and Cellular Biology, 15(6), 885-892.

The contribution of non-insulin-dependent diabetes to lower-extremity amputation in the community. / Humphrey, Linda; Palumbo, Pasquale J.; Butters, Matthew A.; Hallett, John W.; Chu, Chu P.; O'Fallon, W. Michael; Ballard, David J.

In: Molecular and Cellular Biology, Vol. 15, No. 6, 25.04.1994, p. 885-892.

Research output: Contribution to journalArticle

Humphrey, L, Palumbo, PJ, Butters, MA, Hallett, JW, Chu, CP, O'Fallon, WM & Ballard, DJ 1994, 'The contribution of non-insulin-dependent diabetes to lower-extremity amputation in the community', Molecular and Cellular Biology, vol. 15, no. 6, pp. 885-892.
Humphrey L, Palumbo PJ, Butters MA, Hallett JW, Chu CP, O'Fallon WM et al. The contribution of non-insulin-dependent diabetes to lower-extremity amputation in the community. Molecular and Cellular Biology. 1994 Apr 25;15(6):885-892.
Humphrey, Linda ; Palumbo, Pasquale J. ; Butters, Matthew A. ; Hallett, John W. ; Chu, Chu P. ; O'Fallon, W. Michael ; Ballard, David J. / The contribution of non-insulin-dependent diabetes to lower-extremity amputation in the community. In: Molecular and Cellular Biology. 1994 ; Vol. 15, No. 6. pp. 885-892.
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abstract = "Background: Despite the significant public health burden of lower-extremity amputations in diabetes mellitus, few data are available on the epidemiology of lowerextremity amputations in diabetes mellitus in the community setting. Methods: A retrospective incidence cohort study based in Rochester, Minn, was conducted. Results: Among the 2015 diabetic individuals free of lowerextremity amputation at the diagnosis of diabetes mellitus, 57 individuals underwent 79 lower-extremity amputations (incidence, 375 per 100 000 person-years; 95{\%} confidence interval, 297 to 467). Among the 1826 patients with non-insulin-dependent diabetes mellitus, 52 underwent 73 lower-extremity amputations, and the subsequent incidence of lower-extremity amputation among these residents was 388 per 100 000 person-years (95{\%} confidence interval, 304 to 487). Of the 137 insulin-dependent diabetic patients, four subsequently underwent five lowerextremity amputations (incidence, 283 per 100 000 personyears; 95{\%} confidence interval, 92 to 659). Twenty-five years after the diagnosis of diabetes mellitus, the cumulative risk of one lower-extremity amputation was 11.2{\%} in insulin-dependent diabetes mellitus and 11.0{\%} in noninsulin-dependent diabetes mellitus. When compared with lower-extremity amputation rates for Rochester residents without diabetes, patients with non-insulin-dependent diabetes mellitus were nearly 400 times more likely to undergo an initial transphalangeal amputation (rate ratio, 378.8) and had almost a 12-fold increased risk of a belowknee amputation (rate ratio, 11.8). In this community, more than 60{\%} of lower-extremity amputations were attributable to non-insulin-dependent diabetes mellitus. Conclusions: These population-based data document the magnitude of the elevated risk of lower-extremity amputation among diabetic individuals. Efforts should be made to identify more precisely risk factors for amputation in diabetes and to intervene in the processes leading to amputation.",
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