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The Contribution of Non—Insulin-Dependent Diabetes to Lower-Extremity Amputation in the Community

The Contribution of Non—Insulin-Dependent Diabetes to Lower-Extremity Amputation in the Community Abstract 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.(Arch Intern Med. 1994;154:885-892) References 1. Lindegard P, Jonsson B, Lithner F. Amputations in diabetic patients in Gotland and Umea Counties 1971-1980 . Acta Med Scand. 1984;687:89-93. 2. Whitehouse FW, Jurgensen C, Block MA. The later life of the diabetic amputee: another look at fate of the second leg . Diabetes . 1968;17:520-521. 3. Silbert S. Amputation of the lower extremity in diabetes mellitus: a follow-up study of 294 cases . Diabetes . 1952;1:297-299. 4. Goldner MG. The fate of the second leg in the diabetic amputee . Diabetes . 1960;9:100-103. 5. National Diabetes Advisory Board. The National Long-Range Plan to Combat Diabetes . Washington, DC: National Diabetes Advisory Board; 1987:ix. Department of Health and Human Services publication (NIH) 87-1587. 6. Diabetes Surveillance. Annual 1990 Report . Atlanta, Ga: Division of Diabetes Translation, Centers for Disease Control: 1990:24, 93. 7. Most RS, Sinnock P. The epidemiology of lower extremity amputations in diabetic individuals . Diabetes Care . 1983;6:87-91.Crossref 8. Cotton LT, Berry HE, Higton DIR. Diabetes and vascular surgery . Postgrad Med J. 1971;47:84-85. 9. Centers for Disease Control. The Prevention and Treatment of Complications of Diabetes: A Guide for Primary Care Practitioners . Atlanta, Ga: Dept of Health and Human Services, Public Health Service, Centers for Disease Control; 1990. 10. Kurland LT, Elveback LR, Nobrega FT. Population studies in Rochester and Olmsted County, Minnesota, 1900-1968 . In: Kessler II, Levin ML, eds. The Community as an Epidemiologic Laboratory: A Casebook of Community Studies . Baltimore, Md: Johns Hopkins Press; 1970:47-69. 11. Kurland LT, Molgaard CA. The patient record in epidemiology . Sci Am. 1981; 245:54-63.Crossref 12. Palumbo PJ, Elveback LR, Chu C-P, Connolly DC, Kurland LT. Diabetes mellitus: incidence, prevalence, survivorship and causes of death in Rochester, Minnesota, 1945-1970 . Diabetes . 1976;25:566-573.Crossref 13. National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance . Diabetes . 1979;28:1039-1057.Crossref 14. Melton LJ, Palumbo PJ, Chu C-P. Incidence of diabetes mellitus by clinical type . Diabetes Care . 1983;6:75-86.Crossref 15. Kleinbaum DG, Kupper LL, Morgenstern H. Measures of disease frequency: incidence . In: Kleinbaum DG, Kupper LL, Morgenstern H, eds. Epidemiologic Research: Principles and Quantitative Methods . Belmont, Calif: Lifetime Learning Publications; 1982:96-116. 16. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations . J Am Stat Assoc. 1958;53:457-481.Crossref 17. Ballard DJ, Butters MA, Hallett JW, Bailey KR, Palumbo PJ, Melton LJ. Seculartrends in lower extremity amputations and revascularization procedures: a population-based study in Rochester, Minnesota, 1950-1984 . Clin Res. 1987;35:729A. Abstract. 18. Hennekens CH, Buring JE. Measures of disease frequency and association . In: Mayrent SL, ed. Epidemiology in Medicine . Boston, Mass: Little Brown & Co; 1987:54-98. 19. Harris MI, Hadden WC, Knowler WC, Bennett PH. Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in U.S. population aged 20-74 yr . Diabetes . 1987;36:523-534.Crossref 20. O'Fallon WM, Sicks JD. Attributable risk . In: Whisnant JP, ed. Stroke: Populations, Cohorts, and Clinical Trials . London, England: Butterworth-Heinemann Ltd; 1993:111-134. 21. Nelson RG, Gohdes DM, Everhart JE, et al. Lower-extremity amputations in non—insulin-dependent diabetes: 12-yr follow-up study in Pima Indians . Diabetes Care . 1988;11:8-16.Crossref 22. Moss SE, Klein R, Klein BEK. The prevalence and incidence of lower extremity amputation in a diabetic population . Arch Intern Med. 1992;152:610-616.Crossref 23. Kreines K, Johnson E, Albrink M, et al. The course of peripheral vascular disease in non-insulin-dependent diabetes . Diabetes Care . 1985;8:235-243.Crossref 24. Centers for Disease Control. Lower extremity amputations among persons with diabetes mellitus—Washington, 1988 . MMWR Morb Mortal Wkly Rep. 1991;40: 737-739. 25. Bild DE, Selby JV, Sinnock P, Browner WS, Braveman P, Showstack JA. Lower-extremity amputation in people with diabetes: epidemiology and prevention . Diabetes Care . 1989;12:24-31.Crossref 26. Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation: basis for prevention . Diabetes Care . 1990;13:513-521.Crossref 27. Edmonds ME, Blundell MP, Morris ME, Thomas EM, Cotton LT, Watkins PJ. Improved survival of the diabetic foot: the role of a specialised foot clinic . Q J Med. 1986;60:763-771. 28. Assal JP, Mühlhauser I, Pernet A, Gfeller R, Jörgens V, Berger M. Patient education as the basis for diabetes care in clinical practice and research . Diabetologia . 1985;28:602-613.Crossref 29. Runyan JW. The Memphis chronic disease program . JAMA . 1975;231:264-267.Crossref 30. Hobgood E. Conservative therapy of foot abnormalities, infections, and vascular insufficiency . In: Davidson JK, ed. Clinical Diabetes Mellitus . New York, NY: Thieme Inc; 1986:397-406. 31. Reiber GE, Pecoraro RE, Koepsell TD. Risk factors for amputation in patients with diabetes mellitus . Ann Intern Med. 1992;117:97-105.Crossref 32. Gloviczki P, Morris SM, Bower TC, Toomey BJ, Naessens JM, Stanson AW. Microvascular pedal bypass for salvage of the severely ischemic limb . Mayo Clin Proc. 1991;66:243-253.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

The Contribution of Non—Insulin-Dependent Diabetes to Lower-Extremity Amputation in the Community

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420080085009
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Abstract

Abstract 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.(Arch Intern Med. 1994;154:885-892) References 1. Lindegard P, Jonsson B, Lithner F. Amputations in diabetic patients in Gotland and Umea Counties 1971-1980 . Acta Med Scand. 1984;687:89-93. 2. Whitehouse FW, Jurgensen C, Block MA. The later life of the diabetic amputee: another look at fate of the second leg . Diabetes . 1968;17:520-521. 3. Silbert S. Amputation of the lower extremity in diabetes mellitus: a follow-up study of 294 cases . Diabetes . 1952;1:297-299. 4. Goldner MG. The fate of the second leg in the diabetic amputee . Diabetes . 1960;9:100-103. 5. National Diabetes Advisory Board. The National Long-Range Plan to Combat Diabetes . Washington, DC: National Diabetes Advisory Board; 1987:ix. Department of Health and Human Services publication (NIH) 87-1587. 6. Diabetes Surveillance. Annual 1990 Report . Atlanta, Ga: Division of Diabetes Translation, Centers for Disease Control: 1990:24, 93. 7. Most RS, Sinnock P. The epidemiology of lower extremity amputations in diabetic individuals . Diabetes Care . 1983;6:87-91.Crossref 8. Cotton LT, Berry HE, Higton DIR. Diabetes and vascular surgery . Postgrad Med J. 1971;47:84-85. 9. Centers for Disease Control. The Prevention and Treatment of Complications of Diabetes: A Guide for Primary Care Practitioners . Atlanta, Ga: Dept of Health and Human Services, Public Health Service, Centers for Disease Control; 1990. 10. Kurland LT, Elveback LR, Nobrega FT. Population studies in Rochester and Olmsted County, Minnesota, 1900-1968 . In: Kessler II, Levin ML, eds. The Community as an Epidemiologic Laboratory: A Casebook of Community Studies . Baltimore, Md: Johns Hopkins Press; 1970:47-69. 11. Kurland LT, Molgaard CA. The patient record in epidemiology . Sci Am. 1981; 245:54-63.Crossref 12. Palumbo PJ, Elveback LR, Chu C-P, Connolly DC, Kurland LT. Diabetes mellitus: incidence, prevalence, survivorship and causes of death in Rochester, Minnesota, 1945-1970 . Diabetes . 1976;25:566-573.Crossref 13. National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance . Diabetes . 1979;28:1039-1057.Crossref 14. Melton LJ, Palumbo PJ, Chu C-P. Incidence of diabetes mellitus by clinical type . Diabetes Care . 1983;6:75-86.Crossref 15. Kleinbaum DG, Kupper LL, Morgenstern H. Measures of disease frequency: incidence . In: Kleinbaum DG, Kupper LL, Morgenstern H, eds. Epidemiologic Research: Principles and Quantitative Methods . Belmont, Calif: Lifetime Learning Publications; 1982:96-116. 16. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations . J Am Stat Assoc. 1958;53:457-481.Crossref 17. Ballard DJ, Butters MA, Hallett JW, Bailey KR, Palumbo PJ, Melton LJ. Seculartrends in lower extremity amputations and revascularization procedures: a population-based study in Rochester, Minnesota, 1950-1984 . Clin Res. 1987;35:729A. Abstract. 18. Hennekens CH, Buring JE. Measures of disease frequency and association . In: Mayrent SL, ed. Epidemiology in Medicine . Boston, Mass: Little Brown & Co; 1987:54-98. 19. Harris MI, Hadden WC, Knowler WC, Bennett PH. Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in U.S. population aged 20-74 yr . Diabetes . 1987;36:523-534.Crossref 20. O'Fallon WM, Sicks JD. Attributable risk . In: Whisnant JP, ed. Stroke: Populations, Cohorts, and Clinical Trials . London, England: Butterworth-Heinemann Ltd; 1993:111-134. 21. Nelson RG, Gohdes DM, Everhart JE, et al. Lower-extremity amputations in non—insulin-dependent diabetes: 12-yr follow-up study in Pima Indians . Diabetes Care . 1988;11:8-16.Crossref 22. Moss SE, Klein R, Klein BEK. The prevalence and incidence of lower extremity amputation in a diabetic population . Arch Intern Med. 1992;152:610-616.Crossref 23. Kreines K, Johnson E, Albrink M, et al. The course of peripheral vascular disease in non-insulin-dependent diabetes . Diabetes Care . 1985;8:235-243.Crossref 24. Centers for Disease Control. Lower extremity amputations among persons with diabetes mellitus—Washington, 1988 . MMWR Morb Mortal Wkly Rep. 1991;40: 737-739. 25. Bild DE, Selby JV, Sinnock P, Browner WS, Braveman P, Showstack JA. Lower-extremity amputation in people with diabetes: epidemiology and prevention . Diabetes Care . 1989;12:24-31.Crossref 26. Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation: basis for prevention . Diabetes Care . 1990;13:513-521.Crossref 27. Edmonds ME, Blundell MP, Morris ME, Thomas EM, Cotton LT, Watkins PJ. Improved survival of the diabetic foot: the role of a specialised foot clinic . Q J Med. 1986;60:763-771. 28. Assal JP, Mühlhauser I, Pernet A, Gfeller R, Jörgens V, Berger M. Patient education as the basis for diabetes care in clinical practice and research . Diabetologia . 1985;28:602-613.Crossref 29. Runyan JW. The Memphis chronic disease program . JAMA . 1975;231:264-267.Crossref 30. Hobgood E. Conservative therapy of foot abnormalities, infections, and vascular insufficiency . In: Davidson JK, ed. Clinical Diabetes Mellitus . New York, NY: Thieme Inc; 1986:397-406. 31. Reiber GE, Pecoraro RE, Koepsell TD. Risk factors for amputation in patients with diabetes mellitus . Ann Intern Med. 1992;117:97-105.Crossref 32. Gloviczki P, Morris SM, Bower TC, Toomey BJ, Naessens JM, Stanson AW. Microvascular pedal bypass for salvage of the severely ischemic limb . Mayo Clin Proc. 1991;66:243-253.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Apr 25, 1994

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