As the prevalence of diabetes rises, more people will face the complications of diabetes, including lower extremity amputation. However, there may be a ray of hope in the form of a recent study in PLOS One that notes a significant reduction in amputation rates among patients with diabetes in Italy.1
Researchers analyzed hospital discharge data and noted that a mean number of 11,639 individuals in Italy had a lower extremity amputation annually from 2001 to 2010 and 58.6 percent of those patients had diabetes. During the study period, there was a 30.7 percent reduction of rates of major amputations among people with diabetes while minor amputation rates declined by 4.6 percent. The authors say the lower amputation rate suggests an earlier and more diffuse approach aimed at limb salvage.
I think the amputation rates might be attributable to greater awareness about the scope of the problem. Italian units have been leaders in treatment of the diabetic lower extremity for the last 20 or more years.
Additionally, further attention given to aggressive revascularization and concomitant foot care has been very helpful. The fact is that the "toe and flow" team model is alive and well in Italy.
1. Lombardo FL, Maggini M, De Bellis A, et al. Lower extremity amputations in persons with and without diabetes in Italy: 2001-10. PLOS One. 2014; 9(1):e86405.