What is the frequency of diabetes-related lower leg amputations in Germany?: An analysis based on routine data

Background and objective: The total number of lower limb amputations in Germany as well as the frequency of lower limb amputations attributable to diabetes is unknown. Currently available estimates are based on regional studies resulting in different totals. The aim of this study was to perform a census of all lower limb amputations in Germany in order to obtain valid estimates of the number of amputations attributable to diabetes mellitus in Germany. Patients and methods: Hospital performance and expenditure statistics were used to obtain a comprehensive count of lower limb amputations. The number of amputations in diabetic patients as well as the number of diabetes-related amputations were assessed by calculating the proportion of diabetes among amputatees as well as attributable amputations standardized to the age and gender distribution in Germany in 2001, using routine data from the Local Health Insurance Funds (AOK) as well as previous analyses from Germany. Results: In 2001, 43,544 lower limb amputations and additional 3,981 revisions of amputations were performed in Germany. Among these almost 29,000 lower limb amputations were estimated to be performed in diabetic patients. More than 26,000 lower limb amputations per year were estimated to have been attributable to pre-existing diabetes mellitus. Conclusions: Lower limb amputations as a complication of diabetes mellitus are more frequent in Germany than previously estimated. Intensified prevention and therapy - as intended in disease management programs - are urgently needed to decrease the complications of diabetes and ultimately to reduce diabetes mellitus-related costs.