Will U.S. Amputation Rates Continue To Fall In People With Diabetes?

David G. Armstrong DPM MD PhD

There may be some good news in regard to amputation rates in patients with diabetes in the United States.

A recent study in Diabetes Care found that nontraumatic lower extremity amputation rates have decreased in patients with diabetes over age 40.1 Lin and colleagues found the amputation discharge rate per 1,000 people with diabetes was 3.9 in 2008 — down from 11.2 in 1996.

The decrease in amputation comes despite the rise in diabetes prevalence in the same period. The authors attribute the increased disease prevalence to improved survival rates and the fact that more people are being diagnosed with diabetes. They note that those whose diabetes was detected earlier may not have had the disease long enough to develop complications. However, the study authors warn: “Once these patients with new-onset, milder disease have had diabetes long enough, it is possible that the encouraging trends in nontraumatic lower extremity amputations will reverse."

Bottom line: Amputations have been falling since 1996 in the United States. During this same period, changes in the definition of diabetes likely brought many more new-onset patients into the population. In other words, our denominator increased and “duration of diabetes” may have decreased. We'd like to think we're making a difference and it appears as though we are making a difference. However, what we really have to ask is:

Is this a day at the beach or the calm before the next big wave?

Reference

1. Li Y, Burrows NR, Gregg EW, Albright A, Geiss LS. Declining rates of hospitalization for nontraumatic lower-extremity amputation in the diabetic population aged 40 years or older: U.S., 1988-2008. Diabetes Care. 2012; 35(2):273-7.

This blog has been adapted with permission from a previous blog that originally appeared at www.diabeticfootonline.blogspot.com .

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