Decreasing incidence of major amputations in people with diabetes

Aims/hypothesis. To assess the results of the strategy used in avoiding maj or amputations in patients with diabetes mellitus. Methods. A retrospective study for the years 1981 to 1995 in a central dist rict hospital in Copenhagen with a catchment area population of about 178,0 00. Results. There were 463 major leg amputations and the incidence decreased f rom 27.2 to 6.9/100,000 population (75 %). The decrease in patients with Ty pe I (insulin-dependent) diabetes mellitus was from 10.0 to 4.1 (59 %) and in Type II (non-insulin-dependent) diabetes mellitus from 17.2 to 2.8/100,0 00 people (84 %). Analysis showed that the diabetic population remained con stant despite a considerable fall in the number of older people. During the study period infra-popliteal arterial bypass was introduced for the treatm ent of critical lower limb ischaemia and in diabetic patients the number of bypasses increased from zero to 13/100,000 population, The total number of revascularisation procedures in people with diabetes increased from 2.6 to 19.2/ 100,000 population. Moreover, a multidisciplinary diabetic foot clin ic was established. Conclusion/interpretation. A 75 % reduction in the incidence of major amput ations coincided with a sevenfold increase in revascularization procedures and the establishment of a multidisciplinary diabetic foot clinic suggestin g these measures are important in the prevention of diabetic leg amputation s.