OBJECTIVE — To describe recent trends in the incidence of nontraumatic amputations
among individuals with and without diabetes and estimate the relative risk of amputations
among individuals with diabetes in England.
RESEARCH DESIGN AND METHODS — We identified all patients aged 16 years
who underwent any nontraumatic amputation in England between 2004 and 2008 using national
hospital activity data from all National Health Service hospitals. Age- and sex-specific
incidence rates were calculated using the total diabetes population in England every year. To test
for time trend, we fitted Poisson regression models.
RESULTS — The absolute number of diabetes-related amputations increased by 14.7%, and
the incidence decreased by 9.1%, from 27.5 to 25.0 per 10,000 people with diabetes, during the
study period (P 0.2 for both). The incidence of minor and major amputations did not
significantly change (15.7–14.9 and 11.8–10.2 per 10,000 people with diabetes; P 0.66 and
P 0.29, respectively). Poisson regression analysis showed no statistically significant change in
diabetes-related amputation incidence over time (0.98 decrease per year [95% CI 0.93–1.02];
P 0.12). Nondiabetes-related amputation incidence decreased from 13.6 to 11.9 per 100,000
people without diabetes (0.97 decrease by year [0.93–1.00]; P 0.059). The relative risk of an
individual with diabetes undergoing a lower extremity amputation was 20.3 in 2004 and 21.2 in
2008, compared with that of individuals without diabetes.
CONCLUSIONS — This national study suggests that the overall population burden of amputations
increased in people with diabetes at a time when the number and incidence of amputations
decreased in the aging nondiabetic population.