NEW YORK (Reuters Health) - The risk of having a foot or leg amputated remains high among patients with type 1 or "insulin-dependent" diabetes, according to findings from a Swedish study.
It has been estimated worldwide that one lower limb is amputated every 30 seconds as a consequence of this condition, note Dr. Junmei Miao Jonasson, of Karolinska Institute, Stockholm, and colleagues in the current issue of Diabetes Care.
Diabetic foot ulcers are "the most common first indicator" of impending lower-extremity amputations related to diabetes, they also point out.
Among 31,354 men and women with type 1 diabetes in the Swedish Inpatient Register between 1975 and 2004, a total of 465 had a lower-extremity amputation that was not due to an injury or other traumatic event, Jonasson's team discovered.
The risk of amputation, they report, was 40 percent lower during the most recent calendar period (2000 to 2004) than during the previous calendar period.
However, compared to the matched general population, the risk for non-traumatic lower-extremity amputation even in the most recent calendar period was significantly higher among patients with than without type 1 diabetes.
The cumulative probability of lower-extremity amputation by age 65 for people with type 1 diabetes was 11.0 percent for women and 20.7 percent for men.
"In summary, even though our data do suggest that the risk of non-traumatic lower-extremity amputation among patients with type 1 diabetes has attenuated in recent years, patients diagnosed with this disease before age 31 years nonetheless have strikingly high absolute and relative risks of non-traumatic lower-extremity amputations," Jonasson and colleagues write.
"The apparent decline in the risks indicates that recent preventive efforts have been effective, but the findings documented here emphasize the need for the unrelenting application of measures designed to prevent non-traumatic lower-extremity amputations early in the course of type 1 diabetes," the team concludes.
Diabetes Care August 2008.
