Twenty years with diabetes and amputations: A retrospective population-based cohort study

Aim: To investigate the trends in non-traumatic lower limb amputation in people with and without diabetes. Methods: From the Danish National Patient Register, all people with either type 1 or type 2 diabetes (n = 462 743) as well as a group of people without diabetes from the general population (n = 1 388 886) were identified and separated into three groups based on diabetes type. Among these, 17 265 amputations were identified between 1997 and 2017 and stratified into trans-femoral amputations, trans-tibial amputations and amputations below the ankle using surgical codes. Annual changes were described using least-squares linear regression. Results: The yearly mean decrease in incidence rate of amputation per 1000 person-years was −0.032 [95% CI: −0.062, −0.001], −0.022 [−0.032, −0.012] and −0.006 [−0.009, −0.003] for trans−femoral amputation, −0.072 [−0.093, −0.052], −0.090 [−0.102, −0.078] and −0.015 [−0.016, −0.013] for trans-tibial amputation, and −0.055 [−0.080, −0.020], −0.075 [−0.090, −0.060] and −0.011 [−0.014, −0.007] for amputation below the ankle in people with type 1 diabetes, people with type 2 diabetes and people without diabetes, respectively. Conclusions: Over recent decades, the incidence of amputation has decreased significantly in people with diabetes and in the general population without diabetes.