Clinical Edge

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Diabetes-Related Lower Extremity Amputations

Diabetes Care; ePub 2018 Nov 8; Geiss, et al

Following a 2-decade decline in diabetes-related lower extremity amputations, the US may now be experiencing a reversal in the progress, particularly in young and middle-aged. This according to a recent study that sought to determine whether declining trends in diabetes-related lower extremity amputations have continued into the current decade. Researchers calculated hospitalization rates for nontraumatic lower extremity amputation (NLEA) for the years 2000-2015 using nationally representative, serial cross-sectional data from the Nationwide Inpatient Sample on NLEA procedures and from the National Health Interview Survey for estimates of the populations with and without diabetes. They found:

  • Age-adjusted NLEA rates per 1,000 adults with diabetes decreased 43% between 2000 and 2009 but then rebounded by 50% between 2009 and 2015.
  • Conversely, age-adjusted NLEA rates per 1,000 adults without diabetes decreased from 0.23 per 1,000 in 2000 to 0.18 per 1,000 in 2015.
  • The increased in diabetes-related NLEA rates between 2009 and 2015 was driven by a 62% increase in the rate of minor amputations and a smaller but statistically significant 29% increase in major NLEAs.
  • These increases were most pronounced in young (aged 18-44 years) and middle-aged (aged 45-64 years) adults and more marked in men vs women.


Geiss LS, Li Y, Hora I, Albright A, Rolka D, Gregg EW. Resurgence of diabetes-related nontraumatic lower extremity amputation in the young and middle-aged adult U.S. population. [Published online ahead of print November 8, 2018]. Diabetes Care. doi:10.2337/dc18-1380.