TY - JOUR
T1 - The contribution of non-insulin-dependent diabetes to lower-extremity amputation in the community
AU - Humphrey, Linda L.
AU - Palumbo, Pasquale J.
AU - Butters, Matthew A.
AU - Hallett, John W.
AU - Chu, Chu Pin
AU - O'Fallon, W. Michael
AU - Ballard, David J.
N1 - Funding Information:
Bethesda, Md. Dr Ballard is supported, in part, by a ca¬ reerdevelopmentawardfromtheMerck,Sharp&Dohmel SocietyforEpidemiologieResearch Clinical Epidemiology FellowshipWewishProgram.tothank Hurless Kay forcomputerpro¬ grammingandLesleyWelchAllenforeditorialassistance. Reprint requests to The ThomasJefferson Health Policy Institute, Pantops Dr, Charlottesville, (DrBallard).175BS VA22901
PY - 1994/4/25
Y1 - 1994/4/25
N2 - Background: Despite the significant public health burden of lower- extremity amputations in diabetes mellitus, few data are available on the epidemiology of lower-extremity 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 lower-extremity 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 lower-extremity amputations (incidence, 283 per 100 000 person-years; 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 non-insulin-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 below-knee 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.
AB - Background: Despite the significant public health burden of lower- extremity amputations in diabetes mellitus, few data are available on the epidemiology of lower-extremity 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 lower-extremity 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 lower-extremity amputations (incidence, 283 per 100 000 person-years; 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 non-insulin-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 below-knee 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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U2 - 10.1001/archinte.154.8.885
DO - 10.1001/archinte.154.8.885
M3 - Article
C2 - 8154951
AN - SCOPUS:11944272449
SN - 0003-9926
VL - 154
SP - 885
EP - 892
JO - Archives of internal medicine
JF - Archives of internal medicine
IS - 8
ER -