Advanced Podiatry Care in the Diabetic Population - Part I

Objective: To discuss estimated amputations related to diabetes, major amputation risk factors, and the role of risk stratification.

Methods: Utilizing the Uniform Hospital Data Discharge System (UHDDS), ICD-9 (250.0-250.9) and CPT (84.10-84.19) codes were used to identify diabetics undergoing non-traumatic amputation during the same hospitalization. National amputation rates were obtained utilizing the National Health and Nutrition Examination Survey (NHANES). Risk factors and the role of risk stratification identification included a literature review using the search terms “foot ulcer”, “amputation”, and “prevention” with online databases, consulting additional experts, and hand searching of key journals.

Results: By use of UHDDS, BRFSS, and US Census data, the average age-adjusted number of diabetic-related amputations in 2004 was 30.8/100,000 and 5.3/1000 diabetics in MA. National 2004 lower extremity amputations among people with diabetes per 100,000 population age 18 years and older is 38.3. It was found that amputation rates for men is 2.6 times higher than for women, and 2.7 times higher for African-Americans than for white, non-Hispanics in MA. Other high risk groups were patients >65 years old, < high school education, and <$5k household income. Risk factors leading to amputation include foot ulcers, peripheral neuropathy, peripheral vascular disease, foot deformity and limited joint mobility, retinopathy, and history of prior foot ulcer or foot infection.

Conclusions: Diabetes is a major cause of non-traumatic lower extremity amputations with more than 80,000 amputations performed per year in the US. A uniform amputation risk stratification approach will improve multi-disciplinary communication, thereby improving quality of care and patient outcomes.