Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Diabetologia. 2018 Sep;61(9):1966-1977. doi: 10.1007/s00125-018-4655-6. Epub 2018 Jun 16.
AIMS/HYPOTHESIS: The reduction of major lower-extremity amputations (LEAs) is one of the main goals in diabetes care. Our aim was to estimate annual LEA rates in individuals with and without diabetes in Belgium, and corresponding time trends.
Data for 2009-2013 were provided by the Belgian national health insurance funds, covering more than 99% of the Belgian population (about 11 million people). We estimated the age-sex standardised annual amputation rate (first per year) in the populations with and without diabetes for major and minor LEAs, and the corresponding relative risks. To test for time trends, Poisson regression models were fitted.
A total of 5438 individuals (52.1% with diabetes) underwent a major LEA, 2884 people with above- and 3070 with below-the-knee major amputations. A significant decline in the major amputation rate was observed in people with diabetes (2009: 42.3; 2013: 29.9 per 100,000 person-years, 8% annual reduction, p < 0.001), which was particularly evident for major amputations above the knee. The annual major amputation rate remained stable in individuals without diabetes (2009: 6.1 per 100,000 person-years; 2013: 6.0 per 100,000 person-years, p = 0.324) and thus the relative risk reduced from 6.9 to 5.0 (p < 0.001). A significant but weaker decrease was observed for minor amputation in individuals with and without diabetes (5% and 3% annual reduction, respectively, p < 0.001).
CONCLUSIONS/INTERPRETATION: In this nationwide study, the risk of undergoing a major LEA in Belgium gradually declined for individuals with diabetes between 2009 and 2013. However, continued efforts should be made to further reduce the number of unnecessary amputations.
目的/假设：减少主要下肢截肢（LEA）是糖尿病护理的主要目标之一。我们的目的是估计比利时有和没有糖尿病的个体的每年 LEA 发生率，并相应的时间趋势。
2009-2013 年的数据由比利时国家健康保险基金提供，覆盖了比利时 99%以上的人口（约 1100 万人）。我们在有和没有糖尿病的人群中估计了主要和次要 LEA 的年龄性别标准化年截肢率（第一年），以及相应的相对风险。为了检验时间趋势，我们拟合了泊松回归模型。
共有 5438 人（52.1%有糖尿病）接受了主要 LEA，2884 人接受了膝上和 3070 人接受了膝下主要截肢。在有糖尿病的人群中，主要截肢率显著下降（2009 年：42.3；2013 年：29.9/100000 人年，每年下降 8%，p<0.001），尤其是膝上主要截肢更为明显。在没有糖尿病的人群中，每年的主要截肢率保持稳定（2009 年：6.1/100000 人年；2013 年：6.0/100000 人年，p=0.324），因此相对风险从 6.9 降至 5.0（p<0.001）。在有和没有糖尿病的人群中，次要截肢也观察到了显著但较弱的下降（每年分别下降 5%和 3%，p<0.001）。
结论/解释：在这项全国性研究中，2009 年至 2013 年间，比利时有糖尿病的个体接受主要 LEA 的风险逐渐降低。然而，应继续努力进一步减少不必要的截肢。
