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DOI: 10.1055/s-0042-109260
The Diabetic Foot in a Multidisciplinary Team Setting. Number of Amputations below Ankle Level and Mortality
Publication History
received 02 February 2016
first decision 09 May 2016
accepted 25 May 2016
Publication Date:
20 July 2016 (online)
![](https://www.thieme-connect.de/media/eced/201609/lookinside/thumbnails/02-2016-0062-dia_10-1055-s-0042-109260-1.jpg)
Abstract
Aim: To describe the number of minor lower extremity amputations and mortality for diabetes patients treated by a specialized multidisciplinary foot care team.
Methods: A retrospective descriptive study of medical records from patients with diabetes treated with minor amputations at the Copenhagen Wound Healing Center (CWHC) at Bispebjerg Hospital from 1996–2013.
Results: 777 diabetes patients treated with minor amputations were included. 77% were males and 23% were females. 80% had T2 diabetes and 20% had T1 diabetes. 89% of the patients had a foot ulcer at first contact. There was a total of 1 231 minor amputations. The amputations were mainly trans-metatarsal amputations and partial amputations of toes. There was an increase in the number of minor amputations, but there was also an increase in the number of referred diabetes patients, thus the ratio of amputations per admitted diabetes patient was constant. Time from first amputation to death was 2.5 years. The 5-year mortality rate was 43% and 52% for T1 and T2 diabetes patients, respectively.
Conclusion: Due to increased number of referred diabetes patients, the number of diabetes patients undergoing minor amputations increased over the years. Patients with diabetes, who underwent minor amputation, had a high mortality averaging 2.5 year to death; comparable to many types of cancer.
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References
- 1 Boulton A, Vileikyte J, Ragnarson-Tennvall L et al. The global burden of diabetic foot disease. Lancet 2005; 366: 1719-1724
- 2 Jeffcoate WJ, Harding KG.. Diabetic foot ulcers. Lancet 2003; 361: 1545-1551
- 3 Alvarsson A, Sandgren B, Wendel C et al. A retrospective analysis of amputation rates in diabetic patients: can lower extremity amputations be further prevented?. Cardiovasc Diabetol 2012; 11: 18
- 4 Korzon-Burakowska A, Dziemidok P.. Diabetic foot – the need for comprehensive multidisciplinary approach. Ann Agric Environ Med 2011; 18: 314-317
- 5 Kim PJ, Steinberg JS.. Complications of the diabetic foot. Endocrinol Metab Clin North Am 2013; 42: 833-847
- 6 Bakker K, Apelqvist J, Schaper NC.. Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes Metab Res Rev 2012; 28 (Suppl. 01) 225-231
- 7 © Sundhedsstyrelsen. National klinisk retningslinje for udredning og behandling af diabetiske fodsår. [pdf] 2013 26 juni 2013 [cited 2015 24-03-2015]; Available from: http://www.sst.dk
- 8 Rubio JA, Aragon-Sanchez J, Jimenez S et al. Reducing major lower extremity amputations after the introduction of a multidisciplinary team for the diabetic foot. Int J Low Extrem Wounds 2014; 13: 22-26
- 9 Krishnan S, Nash F, Baker N et al. Reduction in diabetic amputations over 11 years in a defined U.K. population: benefits of multidisciplinary team work and continuous prospective audit. Diabetes Care 2008; 31: 99-101
- 10 Holstein P, Ellitsgaard N, Olsen B et al. Decreasing incidence of major amputations in people with diabetes. Diabetologia 2000; 43: 844-847
- 11 Jorgensen ME, Almdal TP, Faerch K.. Reduced incidence of lower-extremity amputations in a Danish diabetes population from 2000 to 2011. Diabet Med 2014; 31: 443-447
- 12 Hedetoft C, Rasmussen A, Fabrin J et al. Four-fold increase in foot ulcers in type 2 diabetic subjects without an increase in major amputations by a multidisciplinary setting. Diabetes Res Clin Pract 2009; 83: 353-357
- 13 Tseng CL, Rajan M, Miller DR et al. Trends in initial lower extremity amputation rates among Veterans Health Administration health care System users from 2000 to 2004. Diabetes Care 2011; 34: 1157-1163
- 14 Lopez-de-Andres A, Martinez-Huedo MA, Carrasco-Garrido P et al. Trends in lower-extremity amputations in people with and without diabetes in Spain, 2001-2008. Diabetes Care 2011; 34: 1570-1576
- 15 Gottrup F, Holstein P, Jorgensen B et al. A new concept of a multidisciplinary wound healing center and a national expert function of wound healing. Arch Surg 2001; 136: 765-772
- 16 Numbers and facts about Copenhagen Wound Healing Center/Tal og fakta om Videncenter for Sårheling. 2015 [cited 2015 02-10-2015]; Danish version]. Available from: https://www.bispebjerghospital.dk/presse-og-nyt/viden/temaer/levende-plaster-heler-saar/Sider/Tal-og-fakta-om-Videncenter-for-S%C3%A5rheling.aspx
- 17 Organization, W.H. . Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia, in Report of a WHO/IDF consultation. W.H.O.a.I.D. Federation, Editor. 2006 WHO: http://www.who.int/diabetes/publications/diagnosis_diabetes2006/en/ 50
- 18 IBM. IBM SPSS Statistics. 2015 [cited 2015 10-06-2015]; Available from: http://www-01.ibm.com/software/analytics/spss/products/statistics/
- 19 Engholm GFJ, Christensen N, Kejs AMT et al NORDCAN: Cancer Incidence, Mortality, Prevalence and Survival in the Nordic Countries 2011. 17-12-2014 [cited 2015 21-04-2015]; 7.0:[
- 20 Uzzaman MM, Jukaku S, Kambal A et al. Assessing the long-term outcomes of minor lower limb amputations: a 5-year study. Angiology 2011; 62: 365-371
- 21 Moulik PK, Mtonga R, Gill GV.. Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology. Diabetes Care 2003; 26: 491-494
- 22 Vamos EP, Bottle A, Majeed A et al. Trends in lower extremity amputations in people with and without diabetes in England, 1996-2005. Diabetes Res Clin Pract 2010; 87: 275-282
- 23 van Houtum WH, Rauwerda JA, Ruwaard D et al. Reduction in diabetes-related lower extremity amputations in The Netherlands: 1991-2000. Diabetes Care 2004; 27: 1042-1046