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"Ulceration
of the foot is the most common first indicator of impending non-traumatic
lower-extremity amputations (LEAs) related to diabetes, and it has been
estimated worldwide that one lower limb is amputated every 30 s as a
consequence of this condition," write Dr. Junmei
Miao Jonasson, of Karolinska
Institute,
Stockholm
, and colleagues.
For
their current study, the researchers identified 31,354 patients with type
1 diabetes (15,001 women and 16,353 men) in the Swedish Inpatient Register
between 1975 and 2004, and cross-linked the records to other databases for
identification of non-traumatic LEAs.
A
total of 465 type 1 diabetic patients underwent non-traumatic LEAs. The
risk of amputation was 40% lower during the most recent calendar period
(2000 to 2004) than during the previous calendar period. However, compared
to the matched general population, the risk for non-traumatic LEAs even in
the most recent calendar period was significantly higher among patients
with type 1 diabetes (standardized incidence ratio, 85.8).
The
cumulative probability of non-traumatic LEA by age 65 years for people
with type 1 diabetes was 11.0% for women and 20.7% for men.
"In
summary, even though our data do suggest that the risk of non-traumatic
LEA among patients with type 1 diabetes has attenuated in recent years,
patients diagnosed with this disease before age 31 years nonetheless have
strikingly high absolute and relative risks of non-traumatic LEAs,"
Dr. Jonasson and colleagues write.
"The
apparent decline in the risks indicates that recent preventive efforts
have been effective, but the findings documented here emphasize the need
for the unrelenting application of measures designed to prevent
non-traumatic LEAs early in the course of type 1 diabetes," the team
concludes.
Diabetes
Care 2008;31:1536-1540.
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