Orthopaedic Knowledge: Diabetic foot team lowers rate of major amputations

Incidence of major diabetic foot amputations decreased 41% in 10 years.

By Gina Brockenbrough
ORTHOPAEDICS TODAY EUROPE 2009; 12:17

Norwegian investigators discovered a significant decrease in the incidence of diabetic foot amputations in one town 10 years after the establishment of a diabetic foot team at the city’s only hospital.

“We have registered a 41% decrease in major diabetic amputations,” Eivind Witsø, MD, said during his presentation at the 10th EFORT Congress. “The decrease reflects the improved quality of the prevention and treatment of diabetic foot ulcers and a general improvement in public health.”

In a previous study of patients with diabetes in the city of Trondheim, Norway, Witsø and his colleagues identified a rate of 4.4 lower extremity amputations per 1,000 patients each year between 1994 and 1997 — a rate he considered high.

Diabetic foot team lowers rate of major amputations

Incidence of major diabetic foot amputations decreased 41% in 10 years.

By Gina Brockenbrough
ORTHOPAEDICS TODAY EUROPE 2009; 12:17

Diabetic foot team

In response, the investigators established the Trondheim Diabetic Foot Team as part of the orthopaedic surgery department at St. Olav’s University Hospital. The team consisted of an orthopaedic surgeon, nurse, podiatrist, prosthetist and orthotist, and focused on preventative care and early treatment.

The investigators compared the incidence of diabetic amputations from 1994 to 1997 with information from 2004 to 2007.

Eivind Witso, MD
Eivind Witsø

Amputations

The investigators found that the overall incidence of diabetic amputations per 1,000 patients with diabetes per year significantly decreased from 4.4 to 2.8 in 10 years.

Although they found that the incidence of minor diabetic amputations also decreased, the difference was not statistically significant.

Witsø said the study revealed no significant difference in the number of vascular interventions performed on patients with diabetes during the decade. He also noted that the diabetic foot team screened nearly 750 patients and performed nearly 6,000 consultations between 1996 and 2006.

A global trend?

During the paper discussion, co-moderator Per Kjaersgaard-Andersen, MD, asked Witsø if there has been a global decrease in the incidence of diabetic amputation.

“No, it’s not a global observation,” Witsø responded. He noted that while some countries have seen a decrease, diabetic foot amputation remains a major problem in other nations. He added that other researchers have observed a decline in diabetic amputations due to preventative care and an increase in vascular interventions.

“Perhaps this is one of the first studies that has shown a decrease in amputations that cannot be explained by an increase in vascular interventions,” Witsø said.

For more information:
Per Kjaersgaard-Andersen, MD, heads the Section for Hip and Knee Replacement, Department of Orthopaedics, Vejle Hospital, DK-7100 Vejle, Denmark; +45-7940-5716; e-mail: pka@dadlnet.dk. He has no direct financial interest in any products or companies mentioned in this article.
Eivind Witsø, MD, can be reached at St. Olav’s University Hospital, Norwegian University of Science, Gate 17, N-7006 Trondheim, Norway, 7030; +47-738-68000; e-mail: eivind.witso@stolav.no. He has no direct financial interest in any products or companies mentioned in this article.

Reference:

Eivind W, Arne L, Stian L. Forty percent decrease in the incidence of diabetic amputations in 10 years. Paper F197. Presented at the 10th EFORT Congress. June 3-6, 2009. Vienna.