PROBLEM OF AMPUTATIONS IN PATIENTS WITH NEWLY-DIAGNOSED DIABETES-MELLITUS

A reduction of 50 % or more in diabetes-related amputations is a prima ry target of the St Vincent Declaration. This is thought to be achieva ble because both primary and secondary preventative healthcare strateg ies are effective in reducing the incidence of diabetic foot ulceratio n and progression to amputation. Unfortunately there is a group who ca nnot benefit from preventative health care, that is, newly diagnosed d iabetic patients with already established severe complications. Using our population-based district diabetes information system we investiga ted, during the period 1 January 1992 to 31 December 96, the incidence and prevalence of lower extremity amputations (LEAs) and the proporti on occurring in patients newly or recently diagnosed as having diabete s. Seventy-nine diabetic patients (59 male, 20 female) were recorded a s having had 94 LEAs, the incidence of diabetes-related LEA being 475 per 100 000 diabetic patient-years. Of these LEAs 16 (20.2 %) were per formed within 1 year of diabetes being diagnosed. This study highlight s an appreciable and previously unrecognized problem: patients present ing with established complications of diabetes who cannot benefit from secondary preventative healthcare. These patients pose a potential ob stacle to achieving targets for reductions in diabetes-related amputat ions. (C) 1998 John Wiley & Sons, Ltd.