Incidence of Lower-limb Amputations in the Diabetic Compared to the Non-diabetic Population. Findings from Nationwide Insurance Data, Germany, 2005–2007

Abstract

Introduction: One major objective is to reduce the risk of lower limb amputation in diabetes mellitus. Nationwide data to incidences of amputations in the diabetic and non-diabetic populations in Germany as well as relative and attributable risks due to diabetes are lacking so far.

Material and Methods: Using data of a nationwide statutory health insurance (1.6 million members), we assessed all first non-traumatic lower-limb amputations between 2005 and 2007. We estimated sex-age-specific and standardized incidences of amputations in the diabetic and non-diabetic populations, and relative and attributable risks due to diabetes.

Results: Of all subjects with a first amputation in the study period 2005–2007 (n=994), 66% had diabetes, 76% were male, mean age (SD) was 67 (13) years. Incidences per 100 000 person years (standardized to the 2004 German population) in the diabetic and the non-diabetic populations: 176.5 (95% confidence interval 156.0–196.9) and 20.0 (17.0–23.1) in men, and 76.9 (61.9–91.8) and 13.4 (10.7–16.2) in women. Standardized relative risks: 8.8 (7.3–10.7) in men and 5.7 (4.3–7.6) in women. Attributable risks among exposed: 0.89 and 0.83 and population attributable risks 0.59 and 0.40, each in men and women, respectively.

Discussion: In our first German nationwide study, we found the relative risk of lower limb amputation in the diabetic compared to the non-diabetic to be lower than in earlier regional studies in Germany, supporting results of regional reductions of the excess amputation risk due to diabetes. A repetition of the study is warranted to further evaluate trends according to the St. Vincent goals.

Key words

lower-limb amputation incidence in the diabetic and non-diabetic population - relative and attributable risks due to diabetes - nationwide insurance data

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