ArticleClinical epidemiology2018
Lower-extremity amputations in people with and without diabetes in Germany, 2008-2012 - an analysis of more than 30 million inhabitants.
Article in Clinical epidemiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.
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Who cites it
27 citing papers in PubMed, 75 citations in OpenAlex.
- Economic analysis of hyperbaric oxygen therapy for the treatment of ischaemic diabetic foot ulcers.Diving and hyperbaric medicine · 2024Trial
- Lower extremity amputations in Switzerland: Trends in patients with and without diabetes, 2013-2023.International journal of cardiology. Cardiovascular risk and prevention · 2026Article
- Dysregulation of circulating damage-associated molecular patterns in diabetic foot syndrome.Frontiers in immunology · 2026Article
- Clinical Complications and Healthcare Resource Utilization Associated with Conventional Management of Sickle Cell Disease with Recurrent Vaso-occlusive Crises and Transfusion-Dependent β-Thalassemia in Germany.PharmacoEconomics - open · 2025Article
- FHIR-standardized data collection on the clinical rehabilitation pathway of trans-femoral amputation patients.Scientific data · 2024Article
- Peripheral Arterial Disease and the Diabetic Foot Syndrome: Neuropathy Makes the Difference! A Narrative Review.Journal of clinical medicine · 2024Review
- Article
- Prediction of diabetic foot amputation using newly revised DIRECT coding system: Comparison of accuracy with that of five existing classification systems.International wound journal · 2023Article
- Physical Activity Treatment in Adults with Type 2 Diabetes Mellitus per National Treatment Guidelines for Germany: A Telephone-Survey-Based Analysis.Healthcare (Basel, Switzerland) · 2022Article
- Therapeutic Alternatives in Diabetic Foot Patients without an Option for Revascularization: A Narrative Review.Journal of clinical medicine · 2022Review
- [Physical and psychological long-term consequences of diabetes mellitus].Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz · 2022Review
- Degree of Safety Against Falls Provided by 4 Different Prosthetic Knee Types in People With Transfemoral Amputation: A Retrospective Observational Study.Physical therapy · 2022Observational
- Relationship Between Plantar Tissue Hardness and Plantar Pressure Distributions in People With Diabetic Peripheral Neuropathy.Frontiers in bioengineering and biotechnology · 2022Article
- [Diabetic foot syndrome-Part 2 : Revascularization, treatment alternatives, care structures, recurrency prophylaxis].Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2021Article
- [Diabetic foot syndrome-Part 1 : Definition, pathophysiology, diagnostics and classification].Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2021Article
- Article
- National and State-Level Trends in Nontraumatic Lower-Extremity Amputation Among U.S. Medicare Beneficiaries With Diabetes, 2000-2017.Diabetes care · 2020Article
- The Role of Lower Extremity Amputation in Chronic Limb-Threatening Ischemia.The International journal of angiology : official publication of the International College of Angiology, Inc · 2020Review
- An Exploratory Research of 18 Years on the Economic Burden of Diabetes for the Romanian National Health Insurance System.International journal of environmental research and public health · 2020Article
- Information and communication technology used by people with lower limb loss in Slovenia.International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation · 2020Article
Corrections and comments
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Authors and funding
15 authors at 9 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background and purposeLower-extremity amputations (LEAs) in people with diabetes are associated with reduced quality of life and increased health care costs. Detailed knowledge on amputation rates (ARs) is of utmost importance for future health care and economics strategies. We conducted the present cohort study in order to estimate the incidences of LEA as well as relative and attributable risk due to diabetes and to investigate time trends for the period 2008-2012.
methodsOn the basis of the administrative data from three large branches of German statutory health insurers, covering ~34 million insured people nationwide (about 40% of the German population), we estimated age-sex-standardized AR (first amputation per year) in the populations with and without diabetes for any, major, and minor LEAs. Time trends were analyzed using Poisson regression.
resultsA total of 108,208 individuals (diabetes: 67.3%; mean age 72.6 years) had at least one amputation. Among people with diabetes, we observed a significant reduction in major and minor ARs during 2008-2012 from 81.2 (95% CI 77.5-84.9) to 58.4 (55.0-61.7), and from 206.1 (197.3-214.8) to 177.0 (169.7-184.4) per 100,000 person-years, respectively. Among people without diabetes, the major AR decreased significantly from 14.3 (13.9-14.8) to 11.6 ([11.2-12.0], 12.0), whereas the minor AR increased from 15.8 (15.3-16.3) to 17.0 (16.5-17.5) per 100,000 person-years. The relative risk (RR) comparing the diabetic with the nondiabetic populations decreased significantly for both major and minor LEAs (4% and 5% annual reduction, respectively).
conclusionIn this large nationwide population, we still found higher major and minor ARs among people with diabetes compared with those without diabetes. However, AR and RR of major and minor LEAs in the diabetic compared with the nondiabetic population decreased significantly during the study period, confirming a positive trend that has been observed in smaller and regional studies in recent years.
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