5. Rates of Diabetes-Related Nontraumatic Lower Extremity
Amputations Again on the Rise Among the U.S. Adults

According to the International Diabetes Federation, amputation is 10 to 20 times more common among people with diabetes than in those without. Every 30 seconds a lower limb or part of a lower limb is estimated to be lost somewhere in the world as a consequence of diabetes.

Recently, a research group at the Centers for Disease Control and Prevention, Atlanta, determined whether the declining trends in lower extremity amputations witnessed during the last two decades have continued into the current decade.

For this, hospitalization rates for nontraumatic lower extremity amputation (NLEA) were calculated for the years 2000–2015. Age-adjusted NLEA rates per 1,000 diabetes affected adults decreased 43% between 2000 (5.38 [95% CI 4.93–5.84]) and 2009 (3.07 [95% CI 2.79–3.34]) (P < 0.001) and then rebounded by 50% between 2009 and 2015 (4.62 [95% CI 4.25–5.00]) (P < 0.001). Meanwhile, age-adjusted NLEA rates per 1,000 adults without diabetes decreased 22%, from 0.23 per 1,000 (95% CI 0.22–0.25) in 2000 to 0.18 per 1,000 (95% CI 0.17–0.18) in 2015 (P < 0.001).

The increase in diabetes-related NLEA rates between 2009 and 2015 was due to a 62% increase in the rate of minor amputations (from 2.03 [95% CI 1.83–2.22] to 3.29 [95% CI 3.01–3.57], P < 0.001) and a smaller, 29% increase in major NLEAs (from 1.04 [95% CI 0.94–1.13] to 1.34 [95% CI 1.22–1.45], statistically significant). The increases in rates of total, major, and minor amputations were most pronounced in young (age 18–44 years) and middle-aged (age 45–64 years) adults and more pronounced in men than women.

The study thus points out that, after a two-decade decline in lower extremity amputations, the U.S. is now probably experiencing a reversal in the progress, chiefly in young and middle-aged adults.

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