Assessing data on the incidence of lower limb amputation in diabetes

Excerpt

To the Editor: Ulceration of the foot is a major complication of diabetes and is the cause of considerable suffering worldwide [1‐5], as well as a very considerable cost to both healthcare services [6, 7] and the patient [8]. But much of the detail on the assessment of the disease burden has centred on the number of amputations performed, despite the fact that amputation is a relatively uncommon outcome, with only 1.8% of 24,200 ulcer episodes documented in the National Diabetes Foot Care Audit of England and Wales resulting in major amputation within 6 months [9]. On the other hand, data on the numbers of amputations performed are fairly reliably documented in hospitals throughout the world and it is, therefore, relatively easy to assess amputation incidence. Nevertheless, a large number of factors need to be considered before such assessments can be compared and before the significance of any differences can be interpreted. Many of these are inherent in the analysis of any electronic health records in diabetes, as has recently been reviewed [10], but the focus of the present commentary is on those factors that require particular consideration when interpreting data on the incidence of amputation of all or part of the lower limb in people with diabetes [3]. Details of population selection (and associated ethnic, socio-demographic and clinical details), assessment of amputation incidence and interpretation of the findings are considered in turn. …