Diabetes-related amputations have dropped by more than 40 per cent in Sweden over the past two decades, an encouraging trend researchers attribute to improvements in patient care.
The research, published in the journal Diabetologia, focused on the health data of just over 46,000 people with type 1 diabetes in the Scandinavian nation between 1998 and 2019. The study sought to determine not just the rate of amputation but how risk factors for surgery may have evolved over time for the group, which was 55 per cent male and 32 years old at the time of enrolment.
During the first three years of study, researchers found the annual probability of amputation was 2.84 per 1,000 patients. By the last few years of study, from 2017 to 2019, this number had dropped to 1.64 per 1,000 patients — a decrease of 42 per cent.
“We see a trend reversal in the period from 2014 to 2016 and a couple of years before that there were evidently declining long-term blood sugar levels and improving kidney function,” said Sara Hallström, first author of the study and a doctoral student in molecular and clinical medicine at Sahlgrenska Academy, University of Gothenburg, according to News Medical.
“These are the risk factors that, in the study, proved to be the major ones for amputation in people with type 1 diabetes.”
One in three Canadians are currently living with prediabetes or diabetes, a disease in which one’s body does not produce insulin or does not properly use the insulin it does produce, according to Diabetes Canada. Diabetes is the leading cause of non-traumatic lower limb amputation among adults, with diabetic Canadians over 20 times more likely to undergo such a procedure than the general population. Eighty-five per cent of these cases are preceded by a foot ulcer.
Foot complications — generally caused by diabetic neuropathy or poor blood circulation to the feet — can necessitate the removal of a limb and place an enormous financial and emotional burden on patients and their loved ones. Diabetes Canada recommends regular foot exams by patients and their healthcare providers, professional evaluation of amputation risk and increased educational efforts among patients to mitigate the need for surgery.
The other risk factors of amputation identified by the study were advanced age, male sex, cardiovascular disease, smoking and hypertension. Researchers said intensive treatment of modifiable risk factors using, for example, ongoing blood-glucose measurement and modern insulin pumps, are likely a big part of the risk reduction that decreased the likelihood of amputation. The country has also established multidisciplinary diabetes foot teams to assist patients with wounds that do not heal properly — usually as a result of vascular impairment or the loss of sensation — improving overall care and sparing many patients from travelling down a difficult road.
“The declining amputation rate for people with diabetes is important, given that amputation is a procedure that causes great suffering and disability for those who have to undergo it,” Hallström said.
For more information on diabetes, support or to connect with other patients, visit Diabetes Canada.
Dave Yasvinski is a writer with Healthing.ca