Amputations in 19 Year Follow-Up: Neuropathy, PAD, Gender all Critical

Amputations and foot ulcers in patients newly diagnosed with Type 2 diabetes mellitus and observed for 19 years. The role of age, gender and co-morbidity – Bruun – Diabetic Medicine – Wiley Online Library:



To determine the prevalence of foot ulcers and the incidence of amputations in patients with Type 2 diabetes observed for 19 years after diagnosis. We investigated the role of gender, age and co-morbidities.


From the Diabetes Care in General Practice study, 1381 patients were included and examined at diabetes diagnosis, at 6 years and at 14 years after diagnosis. Register-based follow-up was for 19 years. Foot ulcers and amputations were related to gender, age and co-morbidities by odds and hazard ratios from logistic and Cox regression models, respectively.


The incidence of any amputation and major amputation was 400 (95% CI 307–512) and 279 (95% CI 203–375) per 100 000 patient-years, respectively. At the three observation points, the foot ulcer prevalences were 2.76% (95% CI 1.89–3.63), 2.93% (95% CI 1.86–4.00) and 4.96% (95% CI 3.10–6.82). Multivariate analyses showed associations between foot ulcers and peripheral neuropathy, peripheral arterial disease, male gender, retinopathy and myocardial infarction. After multivariate adjustment, significant predictors (hazard ratio; 95% CI) of any amputation were peripheral neuropathy (hazard ratio 2.09; 95% CI 1.19–3.69), peripheral arterial disease (hazard ratio 3.43; 95% CI 1.65–7.12), microalbuminuria (hazard ratio 2.11; 95% CI 1.21–3.67), retinopathy (hazard ratio 6.42; 95% CI 2.59–15.90), impaired vision (hazard ratio 6.92; 95% CI 2.35–20.38) and male gender (hazard ratio 2.40; 95% CI 1.31–4.41). For women, the risk of amputation increased with age, but for men the risk was higher when diagnosed with diabetes at a younger age.


Despite improved treatment regimens, the incidence of amputations is still high in this population-based patient sample. Men diagnosed with diabetes before age 65 years and patients with diabetes-related co-morbidities are at particularly high risk of foot ulcers and amputations.

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