The influence of diabetes on temporal trends in lower extremity revascularisation and amputation for peripheral artery disease: a population-based repeated cross-sectional analysis

Aim/Hypothesis — To describe the influence of diabetes on temporal changes in rates of lower extremity revascularisation and amputation for peripheral artery disease (PAD) in Ontario, Canada.

Methods — In this population-based repeated cross-sectional study, we calculated annual rates of lower extremity revascularisation (open or endovascular) and amputation (toe, foot or leg) related to PAD among Ontario residents aged ≥40 years between 2002 and 2019. Annual rate ratios (relative to 2002) adjusted for changes in diabetes prevalence alone, as well as fully adjusted for changes in demographics, diabetes and other comorbidities, were estimated using generalized estimating equation models to model population-level effects while accounting for correlation within units of observation.

Results — Compared with 2002, the Ontario population in 2019 exhibited a significantly higher prevalence of diabetes (18% vs. 10%). Between 2002 and 2019, the crude rate of revascularisation increased from 75.1 to 90.7/100,000 person-years (unadjusted RR=1.10, 95% CI=1.07-1.13). However, after adjustment, there was no longer an increase in the rate of revascularisation (diabetes-adjusted RR=0.98, 95% CI=0.96-1.01, fully-adjusted RR=0.94, 95% CI=0.91-0.96). The crude rate of amputation decreased from 2002 to 2019 from 49.5 to 45.4/100,000 person-years (unadjusted RR=0.78, 95% CI=0.75-0.81), but was more pronounced after adjustment (diabetes-adjusted RR=0.62, 95% CI=0.60-0.64; fully-adjusted RR=0.58, 95% CI=0.56-0.60).

Conclusions/Interpretation — Diabetes prevalence rates strongly influenced rates of revascularisation and amputation related to PAD. A decrease in amputations related to PAD over time was amplified by rising diabetes prevalence rates.