Lower Extremity Amputation Rates in People With Diabetes Mellitus: A Retrospective Population Based Cohort Study in Zwolle Region, The Netherlands

Leonie Rosien; Peter R van Dijk; Jacques Oskam; Maurice E N Pierie; Klaas H Groenier; Rijk O B Gans; Henk J G Bilo

doi:10.1016/j.ejvs.2023.05.030

Lower Extremity Amputation Rates in People With Diabetes Mellitus: A Retrospective Population Based Cohort Study in Zwolle Region, The Netherlands

Eur J Vasc Endovasc Surg. 2023 Aug;66(2):229-236. doi: 10.1016/j.ejvs.2023.05.030. Epub 2023 May 21.

Authors

Leonie Rosien¹, Peter R van Dijk², Jacques Oskam³, Maurice E N Pierie³, Klaas H Groenier⁴, Rijk O B Gans⁵, Henk J G Bilo⁵

Affiliations

¹ Diabetes Centre, Isala, 8025 BP Zwolle, The Netherlands; Innofeet, 8013 PH Zwolle, The Netherlands; Department of Internal Medicine, University Medical Centre Groningen, 9700 RB Groningen, and Groningen University, The Netherlands. Electronic address: L.rosien@isala.nl.
² Diabetes Centre, Isala, 8025 BP Zwolle, The Netherlands; Department of Endocrinology, University Medical Centre Groningen, 9700 AB Groningen, The Netherlands; Department of Internal Medicine, University Medical Centre Groningen, 9700 RB Groningen, and Groningen University, The Netherlands.
³ Department of Surgery, Isala, 8025 AB Zwolle, The Netherlands.
⁴ Diabetes Centre, Isala, 8025 BP Zwolle, The Netherlands.
⁵ Department of Internal Medicine, University Medical Centre Groningen, 9700 RB Groningen, and Groningen University, The Netherlands.

PMID: 37220802
DOI: 10.1016/j.ejvs.2023.05.030

Abstract

Objective: Lower extremity amputations are a major complication of diabetes mellitus (DM). In a previous Dutch study, the incident rate of major amputations was 89.2 per 100 000 person years. The primary aim of this study was to describe the lower extremity amputation rates in people with DM in the Zwolle region, where preventive and curative footcare is organised according to the guidelines of the International Working Group of the Diabetic Foot (IWGDF). The secondary aim was to evaluate outcomes and underlying characteristics of these people.

Methods: This was a retrospective regional population based cohort study. Data from all people with DM treated in primary and secondary care, living in the region Zwolle were collected. All amputations in the period 2017 to 2019 were analysed. Comparisons were made between those with and without an amputation.

Results: In the analysis 5 915 people with DM were included, with a mean age of 67.8 (IQR 57.9, 75.9) years. Of those people, 47% were women and the median HbA1c was 53 (IQR 47, 62) mmol/mol. Over the three year study period 68 amputations were performed in 59 people: 46 minor, 22 major. This translated into an average annual crude amputation incidence rate of non-traumatic major and minor amputations of 41.5 and 86.9 per 100 000 person years among people with diabetes. Compared with those not undergoing amputations, those who underwent an amputation were more often men, older, mainly had T2DM, were treated in secondary care, had higher diastolic blood pressure, worse diabetic footcare profile, longer DM duration and higher HbA1c. At the end of the follow up, 111 people died: 96 (1.6%) without and 15 (25.4%) with amputations (p < .001).

Conclusions: This retrospective study provides detailed insight into the rate of amputations in Dutch people with diabetes in the region Zwolle. Compared with previous Dutch estimates, these data suggest a considerable decrease in the major amputation incidence rate.

Keywords: Amputations; Diabetic foot; Lower extremity amputation; Podiatry; Preventive care.

MeSH terms

Aged
Amputation, Surgical
Cohort Studies
Diabetes Mellitus*
Diabetic Foot* / diagnosis
Diabetic Foot* / epidemiology
Diabetic Foot* / surgery
Female
Glycated Hemoglobin
Humans
Incidence
Lower Extremity / surgery
Male
Netherlands / epidemiology
Retrospective Studies

Substances

Glycated Hemoglobin