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Fewer major amputations among individuals with diabetes in Finland in 1997-2007: a population-based study.

Ikonen TS, Sund R, Venermo M, Winell K - Diabetes Care (2010)

Bottom Line: The cumulative five-year postamputation mortality among diabetic individuals was 78.7%.Approximately half of this change was due to the increasing size of the diabetic population.These results pose a continuous challenge to improve diabetes care.

View Article: PubMed Central - PubMed

Affiliation: THL (National Institute for Health and Welfare), Helsinki, Finland. tuija.ikonen@thl.fi

ABSTRACT

Objective: Complications occur in diabetes despite rigorous efforts to control risk factors. Since 2000, the National Development Programme for the Prevention and Care of Diabetes has worked to halve the incidence of amputations in 10 years. Here we evaluate the impact of the efforts undertaken by analyzing the major amputations done in 1997-2007.

Research design and methods: All individuals with diabetes (n = 396,317) were identified from comprehensive national databases. Data on the first major amputations (n = 9,481) performed for diabetic and nondiabetic individuals were obtained from the National Hospital Discharge Register.

Results: The relative risk for the first major amputation was 7.4 (95% CI 7.2-7.7) among the diabetic versus the nondiabetic population. The standardized incidence of the first major amputation decreased among the diabetic and nondiabetic populations (48.8 and 25.2% relative risk reduction, respectively) over 11 years, and the time from the registration of diabetes to the first major amputation was significantly longer, on average 1.2 years more. The cumulative five-year postamputation mortality among diabetic individuals was 78.7%.

Conclusions: In our nationwide diabetes database, the duration from the registration of diabetes to the first major amputation increased, and the incidence of major amputations decreased almost 50% in 11 years. Approximately half of this change was due to the increasing size of the diabetic population. The risk for major amputation is more than sevenfold that among the nondiabetic population. These results pose a continuous challenge to improve diabetes care.

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Standardized incidence (log scale) of the first major amputation per 100,000 person-years among individuals with diabetes in Finland 1997–2007. Non-DM, individuals without diabetes.
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Figure 1: Standardized incidence (log scale) of the first major amputation per 100,000 person-years among individuals with diabetes in Finland 1997–2007. Non-DM, individuals without diabetes.

Mentions: Over 11 years, the standardized incidence of the first major amputation decreased significantly in all groups (Fig. 1). The decrease among all diabetic individuals was from 94.4 per 100,000 in year 1997 to 48.3 per 100,000 in year 2007, corresponding to 48.8% relative risk reduction. Among individuals without diabetes, the risk for major amputation decreased from 10.7 to 8.0 per 100,000, with a relative risk reduction of 25.2%. We also calculated what the relative risk reduction in amputation incidence would have been among individuals with diabetes from 1997 to 2007 if the diabetic population had changed in the same way as the general population. In that case, the relative risk reduction among individuals with diabetes dropped from 48.8% to 28.8%, i.e., at the same level as the relative risk reduction among the nondiabetic population.


Fewer major amputations among individuals with diabetes in Finland in 1997-2007: a population-based study.

Ikonen TS, Sund R, Venermo M, Winell K - Diabetes Care (2010)

Standardized incidence (log scale) of the first major amputation per 100,000 person-years among individuals with diabetes in Finland 1997–2007. Non-DM, individuals without diabetes.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2992197&req=5

Figure 1: Standardized incidence (log scale) of the first major amputation per 100,000 person-years among individuals with diabetes in Finland 1997–2007. Non-DM, individuals without diabetes.
Mentions: Over 11 years, the standardized incidence of the first major amputation decreased significantly in all groups (Fig. 1). The decrease among all diabetic individuals was from 94.4 per 100,000 in year 1997 to 48.3 per 100,000 in year 2007, corresponding to 48.8% relative risk reduction. Among individuals without diabetes, the risk for major amputation decreased from 10.7 to 8.0 per 100,000, with a relative risk reduction of 25.2%. We also calculated what the relative risk reduction in amputation incidence would have been among individuals with diabetes from 1997 to 2007 if the diabetic population had changed in the same way as the general population. In that case, the relative risk reduction among individuals with diabetes dropped from 48.8% to 28.8%, i.e., at the same level as the relative risk reduction among the nondiabetic population.

Bottom Line: The cumulative five-year postamputation mortality among diabetic individuals was 78.7%.Approximately half of this change was due to the increasing size of the diabetic population.These results pose a continuous challenge to improve diabetes care.

View Article: PubMed Central - PubMed

Affiliation: THL (National Institute for Health and Welfare), Helsinki, Finland. tuija.ikonen@thl.fi

ABSTRACT

Objective: Complications occur in diabetes despite rigorous efforts to control risk factors. Since 2000, the National Development Programme for the Prevention and Care of Diabetes has worked to halve the incidence of amputations in 10 years. Here we evaluate the impact of the efforts undertaken by analyzing the major amputations done in 1997-2007.

Research design and methods: All individuals with diabetes (n = 396,317) were identified from comprehensive national databases. Data on the first major amputations (n = 9,481) performed for diabetic and nondiabetic individuals were obtained from the National Hospital Discharge Register.

Results: The relative risk for the first major amputation was 7.4 (95% CI 7.2-7.7) among the diabetic versus the nondiabetic population. The standardized incidence of the first major amputation decreased among the diabetic and nondiabetic populations (48.8 and 25.2% relative risk reduction, respectively) over 11 years, and the time from the registration of diabetes to the first major amputation was significantly longer, on average 1.2 years more. The cumulative five-year postamputation mortality among diabetic individuals was 78.7%.

Conclusions: In our nationwide diabetes database, the duration from the registration of diabetes to the first major amputation increased, and the incidence of major amputations decreased almost 50% in 11 years. Approximately half of this change was due to the increasing size of the diabetic population. The risk for major amputation is more than sevenfold that among the nondiabetic population. These results pose a continuous challenge to improve diabetes care.

Show MeSH
Related in: MedlinePlus