Global trends in the incidence of hospital admissions for diabetes-related foot disease and amputations: a review of national rates in the 21st century

Lazzarini, Peter A., Cramb, Susanna M., Golledge, Jonathan, Morton, Jedidiah I., Magliano, Dianna J., and Van Netten, Jaap J. (2022) Global trends in the incidence of hospital admissions for diabetes-related foot disease and amputations: a review of national rates in the 21st century. Diabetologia, 66. pp. 267-287.

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Aims/hypothesis: Diabetic foot disease (DFD) is a leading cause of hospital admissions and amputations. Global trends in diabetes-related amputations have been previously reviewed, but trends in hospital admissions for multiple other DFD conditions have not. This review analysed the published incidence of hospital admissions for DFD conditions (ulceration, infection, peripheral artery disease [PAD], neuropathy) and diabetes-related amputations (minor and major) in nationally representative populations.

Methods: PubMed and Embase were searched for peer-reviewed publications between 1 January 2001 and 5 May 2022 using the terms ‘diabetes’, ‘DFD’, ‘amputation’, ‘incidence’ and ‘nation’. Search results were screened and publications reporting the incidence of hospital admissions for a DFD condition or a diabetes-related amputation among a population representative of a country were included. Key data were extracted from included publications and initial rates, end rates and relative trends over time summarised using medians (ranges).

Results: Of 2527 publications identified, 71 met the eligibility criteria, reporting admission rates for 27 countries (93% high-income countries). Of the included publications, 14 reported on DFD and 66 reported on amputation (nine reported both). The median (range) incidence of admissions per 1000 person-years with diabetes was 16.3 (8.4–36.6) for DFD conditions (5.1 [1.3–7.6] for ulceration; 5.6 [3.8–9.0] for infection; 2.5 [0.9–3.1] for PAD) and 3.1 (1.4–10.3) for amputations (1.2 [0.2–4.2] for major; 1.6 [0.3–4.3] for minor). The proportions of the reported populations with decreasing, stable and increasing admission trends were 80%, 20% and 0% for DFD conditions (50%, 0% and 50% for ulceration; 50%, 17% and 33% for infection; 67%, 0% and 33% for PAD) and 80%, 7% and 13% for amputations (80%, 17% and 3% for major; 52%, 15% and 33% for minor), respectively.

Conclusions/interpretation: These findings suggest that hospital admission rates for all DFD conditions are considerably higher than those for amputations alone and, thus, the more common practice of reporting admission rates only for amputations may substantially underestimate the burden of DFD. While major amputation rates appear to be largely decreasing, this is not the case for hospital admissions for DFD conditions or minor amputation in many populations. However, true global conclusions are limited because of a lack of consistent definitions used to identify admission rates for DFD conditions and amputations, alongside a lack of data from low- and middle-income countries. We recommend that these areas are addressed in future studies.

Item ID: 77211
Item Type: Article (Research - C1)
ISSN: 1432-0428
Keywords: Admissions, Amputations, Diabetes complications, Diabetes mellitus, Diabetic foot, Diabetic foot disease, Diabetic foot ulcer, Epidemiology, Hospitalisations, Review
Copyright Information: © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2022.
Funders: National Health and Medical Research Council (NHMRC)
Projects and Grants: NHMRC 1143435, NHMRC 2008313
Date Deposited: 11 Jan 2023 07:40
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320101 Cardiology (incl. cardiovascular diseases) @ 50%
42 HEALTH SCIENCES > 4201 Allied health and rehabilitation science > 420107 Podiatry @ 50%
SEO Codes: 20 HEALTH > 2001 Clinical health > 200101 Diagnosis of human diseases and conditions @ 50%
20 HEALTH > 2004 Public health (excl. specific population health) > 200404 Disease distribution and transmission (incl. surveillance and response) @ 50%
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