Decreasing rates of major lower-extremity amputation in people with diabetes but not in those without: a nationwide study in Belgium

被引：33

作者：

Claessen, Heiner ^{[1
,2
,3
]}

Avalosse, Herve ^{[4
,5
]}

Guillaume, Joeri ^{[4
,6
]}

Narres, Maria ^{[1
,2
,3
]}

Kvitkina, Tatjana ^{[1
,2
,3
]}

Arend, Werner ^{[2
]}

Morbach, Stephan ^{[2
,7
]}

Lauwers, Patrick ^{[8
,9
]}

Nobels, Frank ^{[6
,10
]}

Boly, Jacques ^{[5
]}

Van Hul, Chris ^{[11
]}

Doggen, Kris ^{[12
]}

Dumont, Isabelle ^{[13
,14
]}

Felix, Patricia ^{[13
,15
]}

Van Acker, Kristien ^{[16
]}

Icks, Andrea ^{[1
,2
]}

机构：

[1] Heinrich Heine Univ Dusseldorf, German Diabet Ctr DDZ, Inst Hlth Serv Res & Hlth Econ, Leibniz Inst Diabet Res, Hennekamp 65, D-40225 Dusseldorf, Germany

[2] Heinrich Heine Univ Dusseldorf, Fac Med, Inst Hlth Serv Res & Hlth Econ, Dusseldorf, Germany

[3] German Ctr Diabet Res DZD, Munich, Germany

[4] IMA AIM InterMutualist Agentschap Agence Intermut, Brussels, Belgium

[5] Alliance Natl Mutualites Chretiennes, Landsbond Christelijke Mutualiteiten, Brussels, Belgium

[6] Nationaal Verbond Socialist Mutualiteiten, Union Natl Mutualites Socialistes, Brussels, Belgium

[7] Marien Hosp, Dept Diabet & Angiol, Soest, Germany

[8] Diabet Liga, Ghent, Belgium

[9] Antwerp Univ Hosp, Dept Thorac & Vasc Surg, Edegem, Belgium

[10] Onze Lieve Vrouw Ziekenhuis Aalst, Dept Endocrinol, Aalst, Belgium

[11] Union Mutualites Libres, Landsbond Onafhankelijke Ziekenfondsen, Anderlecht, Belgium

[12] Sci Inst Publ Hlth, Brussels, Belgium

[13] Assoc Belge Diabet, Brussels, Belgium

[14] Ctr Multidisciplinaire Pied Diabet, Ransart, Belgium

[15] CHR Citadelle, Dept Endocrinol, Liege, Belgium

[16] CSF, Dept Diabetol & Endocrinol, D Foot Int Int Working Grp Diabet Foot Implementa, Chimay, Belgium

来源：

DIABETOLOGIA | 2018年 / 61卷 / 09期

关键词：

Amputation rate; Diabetes; Major lower-extremity amputation; Minor lower-extremity amputation; National health insurance funds; LOWER-LIMB AMPUTATIONS; REDUCED INCIDENCE; INDIVIDUALS; NETHERLANDS; POPULATION; ULCERATION; REDUCTION; GERMAN;

D O I：

10.1007/s00125-018-4655-6

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims/hypothesis The reduction of major lower-extremity amputations (LEAs) is one of the main goals in diabetes care. Our aim was to estimate annual LEA rates in individuals with and without diabetes in Belgium, and corresponding time trends. Methods Data for 2009-2013 were provided by the Belgian national health insurance funds, covering more than 99% of the Belgian population (about 11 million people). We estimated the age-sex standardised annual amputation rate (first per year) in the populations with and without diabetes for major and minor LEAs, and the corresponding relative risks. To test for time trends, Poisson regression models were fitted. Results A total of 5438 individuals (52.1% with diabetes) underwent a major LEA, 2884 people with above- and 3070 with below-the-knee major amputations. A significant decline in the major amputation rate was observed in people with diabetes (2009: 42.3; 2013: 29.9 per 100,000 person-years, 8% annual reduction, p < 0.001), which was particularly evident for major amputations above the knee. The annual major amputation rate remained stable in individuals without diabetes (2009: 6.1 per 100,000 person-years; 2013: 6.0 per 100,000 person-years, p = 0.324) and thus the relative risk reduced from 6.9 to 5.0 (p < 0.001). A significant but weaker decrease was observed for minor amputation in individuals with and without diabetes (5% and 3% annual reduction, respectively, p < 0.001). Conclusions/interpretation In this nationwide study, the risk of undergoing a major LEA in Belgium gradually declined for individuals with diabetes between 2009 and 2013. However, continued efforts should be made to further reduce the number of unnecessary amputations.

引用

页码：1966 / 1977

页数：12

共 22 条

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