Introduction
Diabetic foot complications (DFCs) are major sequelae of diabetes and contribute to most causes of non-traumatic lower-extremity amputations (LEAs) worldwide.1 ,2 In addition, patients with DFCs have been known to have higher recurrence rate of ulcers3 and worse survival than that of many common cancers.4 The medical expense of patients with these complications is even higher than the most costly cancers5 6; moreover, patients who received LEAs usually had worsened consequences including lower self-esteem,7 shortened lifespan,8 9 and the burden of social care.5 10
The US has previously reported a decreasing trend in LEAs but a disturbing reversal has been noted in recent years in patients with DFCs.11 Similar trends have been reported in people with end-stage renal diseases.12 Nevertheless, any explanation of the trend of LEAs is challenging because of scant information available. Information regarding risk factors for LEAs in treating patients with DFCs such as age,13 degree of peripheral arterial diseases (PADs)14 and infection,15 renal function,16 and nutritional status17 is required for further investigations.
Because of the robust and comprehensive nature of the Taiwan National Health System database, we were able to report the in-hospital foot diseases characteristics between years 2000 and 2009.18 The annual incidence of diabetes-related LEA in Taiwan between 1998 and 2007 was 3.79 and 2.27/1000/year, respectively.19
The present study was conducted to better understand the prevalence and time trends of patients with DFCs between 2007 and 2014, including demographics of patients, affected foot and major procedures introduced to treat these patients, and LEAs.