DECREASING INCIDENCE OF MAJOR AMPUTATION IN DIABETIC-PATIENTS - A CONSEQUENCE OF A MULTIDISCIPLINARY FOOT CARE TEAM-APPROACH

The purpose of this retrospective study was to evaluate the changes in diabetes-related lower extremity amputations following the implementa tion of a multidisciplinary programme for prevention and treatment of diabetic foot ulcers in a 0.2 million population with a 2.4% prevalenc e of diabetes. All diabetes-related primary amputations from toe to hi p from 1 January 1982 to 31 December 1993 were included. In 294 diabet ic patients, 387 primary major (above the ankle) or minor (through or below the ankle) amputations were performed, constituting 48% of all l ower extremity amputations. The annual number of amputations at all le vels decreased from 38 to 21, equalling a decrease of incidence from 1 9.1 to 9.4/100000 inhabitants (p = 0.001). The incidence of major ampu tations decreased by 78% from 16/1 to 3.6/100000 inhabitants (p<0.001) . The absolute number of amputations with a final level below the ankl e showed no increase, but their proportion increased from 28 to 53% (p <0.001) and the reamputation rate decreased from 36 to 22% (p<0.05) be tween the first and last 3-year period. Thus, a substantial long-term decrease in the incidence of major amputations was seen as well as a d ecrease in the total incidence of amputations in diabetic patients. Se venty-one per cent of the amputations were precipitated by a foot ulce r. These findings indicate that a multidisciplinary approach plays an important role to reduce and maintain a low incidence of major amputat ions in diabetic patients.