FAILURE OF REDUCING LOWER-EXTREMITY AMPUTATIONS IN DIABETIC-PATIENTS - RESULTS OF 2 SUBSEQUENT POPULATION-BASED SURVEYS 1990 AND 1995 IN GERMANY

Background: A 50% reduction of lower extremity amputations during the subsequent 5 year period has been targeted by the St. Vincent-Declarat ion issued in 1989/90 for a better care of diabetic patients across Eu rope. Patients and methods: In two adjacent counties far off major cit y areas 10 hospitals without specialised diabetes centers in the area provide care to about 300 000 inhabitants. Based on the official opera tion books and verified by the individual patient file all patients am putated in the 10 hospitals during the years 1990 and 1995 were evalua ted retrospectively. Results: A total of 119 patients (66 males, 53 fe males, age median 72 years) were amputated in the 10 hospitals 1990, a nd 162 (89 males, 73 females, age median 74 years) in 1995. The propor tion of diabetic amputees amounted to 70.6 and 62.3%, respectively. A trend towards more toe amputations in diabetic versus nondiabetic pati ents was seen in both surveys which reached significance in 1995 (59 v s. 41%; p < 0.05). Based on the total population and the estimated num ber of diabetic patients (5% of the population) 1.4 and 2/10 000 nondi abetics were amputated in 1990 and 1995, respectively, in contrast to 61 and 66/10 000 diabetic individuals, indicating a 44 fold and 33 fol d excess risk of diabetic patients. Conclusion: It is concluded that t hese 2 surveys 5 years apart reveal a failure of reducing lower extrem ity amputations in people with diabetes - despite the objectives of th e St. Vincent-Declaration.