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Epidemiology/Health Services Research
Original research
Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period
  1. Cheng-Wei Lin1,
  2. David G Armstrong2,
  3. Chia-Hung Lin1,
  4. Pi-Hua Liu1,3,
  5. Shih-Yuan Hung1,
  6. Shu-Ru Lee3,
  7. Chung-Huei Huang1,
  8. Yu-Yao Huang1,4,5
  1. 1 Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
  2. 2 Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California (USC), Los Angeles, California, USA
  3. 3 Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
  4. 4 College of Medicine, Chang Gung University, Taoyuan, Taiwan
  5. 5 Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
  1. Correspondence to Dr Yu-Yao Huang; yyh{at}cgmh.org.tw

Abstract

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.

  • Foot Complications
  • Limb Ischemia
  • Revascularization
  • National Health Surveys
  • Lower Limb Amputation

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2019-000795

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    Footnotes

    • Contributors C-WL reached data and wrote the manuscript. DGA contributed to the discussion and reviewed/edited the manuscript. C-HL contributed to the study concept and design and interpretation of data. P-HL researched data and contributed to discussion. S-YH reviewed/edited the manuscript. S-RL researched data. C-HH interpreted data and contributed to discussion. Y-YH contributed to the study design, discussion and wrote the manuscript.

    • Funding This study was supported by project grant from the CMRPD1H0531and CORPG3J0021.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by the Chang Gung Medical Foundation Institutional Review Board (No. 107–2041 C1).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.