Trends in the incidence of lower limb amputation after implementation of a Multidisciplinary Diabetic Foot Unit
Endocrinol Diabetes Nutr. 2017 Apr;64(4):188-197.
doi: 10.1016/j.endinu.2017.02.009.
Epub 2017 Mar 30.
[Article in
English,
Spanish]
Affiliations
- 1 Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Departamento de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España. Electronic address: sjimenezg@salud.madrid.org.
- 2 Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Departamento de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Departamento de Ciencias Biomédicas, Universidad de Alcalá, Alcalá de Henares, Madrid, España.
- 3 Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Departamento de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Alcalá de Henares, Madrid, España.
- 4 Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Departamento de Cirugía Vascular, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
- 5 Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Departamento de Cirugía General, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
Abstract
Backgrounds and objective:
Incidence of lower extremity amputations (LEA) in the population with and without diabetes mellitus (DM) was assessed after implementation of a Multidisciplinary Diabetic Foot Unit (MDFU) during 2008.
Material and methods:
Non-traumatic LEA were analyzed, and those performed before (2001-2007) and after (2008-2014) introduction of the MDFU were compared. LEA were grouped by age and sex. Their incidence was expressed as a rate per 100,000 population per year, adjusted to the standard European population.
Results:
A total of 664 LEA were performed during the 2001-2014 period, 486 (73%) of them in patients with DM. Total LEA incidence was 11.2/105 population in DM versus 3.9/105 in the population without DM. Incidence of major LEA in patients with DM significantly decreased from 6.1/105 population in the 2001-2007 period to 4.5/105 in the 2008-2014 period (p=.03). Joinpoint regression analysis also showed a reduction in the trend of incidence of major LEA in patients with DM, with an annual percentage change of -3.3% [95% CI, -6.2-0.3] (p=.025). No significant differences were found for all other incidences and trends in the diabetic and non-diabetic populations.
Conclusions:
Implementation of a MDFU has been shown to be associated with a significant reduction in major amputation rate in the diabetic population, although the results are not optimal yet. Both results and work at the MDFU should be improved.
Keywords:
Amputación miembro inferior; Diabetes mellitus; Diabetic foot; Diabetic foot clinic; Lower limb amputation; Pie diabético; Unidad de pie diabético.
Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.
MeSH terms
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Aged
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Aged, 80 and over
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Amputation, Surgical / statistics & numerical data*
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Amputation, Surgical / trends
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Diabetic Foot / surgery
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Diabetic Foot / therapy*
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Female
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Hospital Units*
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Hospitals, University
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Humans
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Interdisciplinary Communication
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Leg / surgery*
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Male
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Middle Aged
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Patient Care Team
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Retrospective Studies
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Spain