Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period
Objective To study the prevalence and trends of lower extremity complications of diabetes over an 8-year period in a single nation.Research design and methods Nationwide data for people with type 2 diabetes (T2D) and diabetic foot complications (DFCs) were analyzed over an 8-year period (2007–2014)...
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BMJ Publishing Group
2019-05-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/7/1/e000795.full |
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| author | David G Armstrong Cheng-Wei Lin Chia-Hung Lin Pi-Hua Liu Shih-Yuan Hung Shu-Ru Lee Chung-Huei Huang Yu-Yao Huang |
| author_facet | David G Armstrong Cheng-Wei Lin Chia-Hung Lin Pi-Hua Liu Shih-Yuan Hung Shu-Ru Lee Chung-Huei Huang Yu-Yao Huang |
| author_sort | David G Armstrong |
| collection | DOAJ |
| description | Objective To study the prevalence and trends of lower extremity complications of diabetes over an 8-year period in a single nation.Research design and methods Nationwide data for people with type 2 diabetes (T2D) and diabetic foot complications (DFCs) were analyzed over an 8-year period (2007–2014) from National Health Insurance Research Database using the International Classification of Diseases, Ninth Revision disease coding. The DFCs were defined as ulcers, infections, gangrene, and hospitalization for peripheral arterial disease (PAD). Trends of patient characteristics, foot presentation, and the execution of major procedures were studied, including lower-extremity amputations (LEAs).Results Along with the T2D population increasing over time, the absolute number of people with DFCs increased by 33.4%, but retained a prevalence of around 2% per year. The annual incident of LEAs decreased from 2.85 to 2.06 per 1000 T2D population (p=0.001) with the major LEA proportion decreasing from 56.2% to 47.4% (p<0.001).The mean age of patients increased from 65.3 to 66.3 years and most of the associated comorbidities of diabetes were increased. For example, end-stage renal disease increased from 4.9% to 7.7% (p=0.008). The incidence of gangrene on presentation decreased from 14.7% to 11.3% (p<0.001) with a concomitant increase in vascular interventions (6.2% to 19.5%, p<0.001).Conclusions DFCs remain a sustained major medical problem. These nationwide long-term data suggest trends toward older people with greater comorbidities such as PAD and renal disease. Nevertheless, promising trends of reducing gangrene on presentation paired with increases in vascular interventions support continued vigilance and rapid, coordinated interdisciplinary diabetic foot care. |
| format | Article |
| id | doaj-art-8f708da7897c45b0a36a09bb59f2f8db |
| institution | Kabale University |
| issn | 2052-4897 |
| language | English |
| publishDate | 2019-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-8f708da7897c45b0a36a09bb59f2f8db2024-12-15T15:35:09ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972019-05-017110.1136/bmjdrc-2019-000795Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year periodDavid G Armstrong0Cheng-Wei Lin1Chia-Hung Lin2Pi-Hua Liu3Shih-Yuan Hung4Shu-Ru Lee5Chung-Huei Huang6Yu-Yao Huang7Department of Surgery, USC Keck School of Medicine, Los Angeles, California, USA1 Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, TaiwanDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan1 Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwandirector3 Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan1 Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, TaiwanDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, TaiwanObjective To study the prevalence and trends of lower extremity complications of diabetes over an 8-year period in a single nation.Research design and methods Nationwide data for people with type 2 diabetes (T2D) and diabetic foot complications (DFCs) were analyzed over an 8-year period (2007–2014) from National Health Insurance Research Database using the International Classification of Diseases, Ninth Revision disease coding. The DFCs were defined as ulcers, infections, gangrene, and hospitalization for peripheral arterial disease (PAD). Trends of patient characteristics, foot presentation, and the execution of major procedures were studied, including lower-extremity amputations (LEAs).Results Along with the T2D population increasing over time, the absolute number of people with DFCs increased by 33.4%, but retained a prevalence of around 2% per year. The annual incident of LEAs decreased from 2.85 to 2.06 per 1000 T2D population (p=0.001) with the major LEA proportion decreasing from 56.2% to 47.4% (p<0.001).The mean age of patients increased from 65.3 to 66.3 years and most of the associated comorbidities of diabetes were increased. For example, end-stage renal disease increased from 4.9% to 7.7% (p=0.008). The incidence of gangrene on presentation decreased from 14.7% to 11.3% (p<0.001) with a concomitant increase in vascular interventions (6.2% to 19.5%, p<0.001).Conclusions DFCs remain a sustained major medical problem. These nationwide long-term data suggest trends toward older people with greater comorbidities such as PAD and renal disease. Nevertheless, promising trends of reducing gangrene on presentation paired with increases in vascular interventions support continued vigilance and rapid, coordinated interdisciplinary diabetic foot care.https://drc.bmj.com/content/7/1/e000795.full |
| spellingShingle | David G Armstrong Cheng-Wei Lin Chia-Hung Lin Pi-Hua Liu Shih-Yuan Hung Shu-Ru Lee Chung-Huei Huang Yu-Yao Huang Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period BMJ Open Diabetes Research & Care |
| title | Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period |
| title_full | Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period |
| title_fullStr | Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period |
| title_full_unstemmed | Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period |
| title_short | Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period |
| title_sort | nationwide trends in the epidemiology of diabetic foot complications and lower extremity amputation over an 8 year period |
| url | https://drc.bmj.com/content/7/1/e000795.full |
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