Original Article

Diabetes-related Lower Extremity Amputation Rates Fall Significantly in South Carolina

Authors: William K. Mountford, MS, Jeremy B. Soule, MD, Daniel T. Lackland, DrPH, Stuart R. Lipsitz, ScD, John A. Colwell, MD, PhD

Abstract

Background: The aims of this study are to compare the diabetes-related lower extremity amputation (LEA) rate trend in South Carolina (SC) to that of the United States (US) and to determine changes in LEA rates in SC according to age, race, gender, and amputation site.


Methods: National Hospital Discharge Survey (NHDS) and SC hospital discharge data for 1996 to 2002 were analyzed. ICD-9-CM codes identified all diabetic patients and occurrences of LEA. Linear regression was used to compare the LEA rate trends between SC and the US.


Results: LEA rates are decreasing throughout the study period. The slope is greater in SC compared with US (US slope = −0.00082; SC slope = −0.0015; P = 0.002), signifying a decrease in LEA rates of 1.5/1000 per year in SC and 0.8/1000 per year in the US. Furthermore, LEA rate decreases in SC are significant throughout all ages, races, genders, and amputation levels.


Conclusions: Diabetes-related LEA rates are decreasing in SC more rapidly than in the US. Ongoing community-level education may be assisting in the favorable trends.


Key Points


* Diabetes-related amputation rates are decreasing at a more rapid rate in South Carolina (SC) compared to the United States (US).


* The SC LEA rate decreases are seen for all race-gender and age groups.


* The number of amputation procedures in hospitals are also decreasing at all levels for people with diabetes in SC.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. CDC. Hospital discharge rates for nontraumatic lower extremity amputation by diabetes status: United States, 1997. MMWR Morb Mortal Wkly Rep 2001;50:954–958.
 
2. Mayfield JA, Reiber GE, Sanders LJ, et al. Preventive foot care in people with diabetes. Diabetes Care 1998;21:2161–2177.
 
3. Pieber TR, Holler A, Siebenhofer A, et al. Evaluation of a structured teaching and treatment programme for type 2 diabetes in general practice in a rural area of Austria. Diabet Med 1995;12:349–354.
 
4. Patout CA Jr, Birke JA, Horswell R, et al. Effectiveness of a comprehensive diabetes lower-extremity amputation prevention program in a predominantly low-income African-American population. Diabetes Care 2000;23:1339–1342.
 
5. Valk GD, Kriegsman DM, Assendelft WJ. Patient education for preventing diabetic foot ulceration. Cochrane Database Syst Rev 2001;4:CD001488.
 
6. Valk GD, Kriegsman DM, Assendelft WJ. Patient education for preventing diabetic foot ulceration.Cochrane Database Syst Rev 2005;1:CD001488.
 
7. Colwell JA, Keisler D, Jenkins C, et al. Overview of the Diabetes Initiative of South Carolina. J S C Med Assoc 1998;94:468–472.
 
8. National Hospital Discharge Survey. National Center for Health Statistics, 1996–2002. Available at ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Datasets/NHDS/.
 
9. Dennison C, Pokras R. Design and operation of the National Hospital Discharge Survey: 1988 redesign. Vital Health Stat 1 2000;39 1–42.
 
10. SC-ORS Inpatient Hospital Discharge Data. In: SC-ORS, ed. Columbia, SC: South Carolina Office of Research and Statistics, 1996–2002.
 
11. Meyers R. Classical and Modern Regression with Applications, 2nd ed. Belmont: PWS-KENT, 1990.
 
12. SAS. SAS OnlineDoc 9.1.3. In:. Cary, NC. SAS Institute, Inc, 2004.
 
13. Cowie CC, Rust KF, Byrd-Holt DD, et al. Prevalence of diabetes and impaired fasting glucose in adults in the US population: National Health And Nutrition Examination Survey 1999–2002. Diabetes Care 2006;29:1263–1268.
 
14. CDC. Data & Trends, Hospitalizations for Nontraumatic Lower Extremity Amputations: National Diabetes Surveillance System; 2005.
 
15. Most RS, Sinnock P. The epidemiology of lower extremity amputations in diabetic individuals. Diabetes Care 1983;6:87–91.
 
16. Lavery LA, Ashry HR, van Houtum W, et al. Variation in the incidence and proportion of diabetes-related amputations in minorities. Diabetes Care 1996;19:48–52.
 
17. Lavery LA, van Houtum WH, Ashry HR, et al. Diabetes-related lower-extremity amputations disproportionately affect Blacks and Mexican Americans. South Med J 1999;92:593–599.
 
18. Resnick HE, Valsania P, Phillips CL. Diabetes mellitus and nontraumatic lower extremity amputation in black and white Americans: the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, 1971–1992. Arch Intern Med 1999;159:2470–2475.
 
19. Young BA, Maynard C, Reiber G, et al. Effects of ethnicity and nephropathy on lower-extremity amputation risk among diabetic veterans. Diabetes Care 2003;26:495–501.
 
20. Selby JV, Zhang D. Risk factors for lower extremity amputation in persons with diabetes. Diabetes Care 1995;18:509–516.
 
21. Karter AJ, Ferrara A, Liu JY, et al. Ethnic disparities in diabetic complications in an insured population. JAMA 2002;287:2519–2527.
 
22. Leggetter S, Chaturvedi N, Fuller JH, et al. Ethnicity and risk of diabetes-related lower extremity amputation: a population-based, case-control study of African Caribbeans and Europeans in the United Kingdom. Arch Intern Med 2002;162:73–78.