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Foot and leg amputation related to diabetes and poor circulation on the rise in Ontario


Diabetes and peripheral artery disease (poor circulation) are responsible for more than 80 per cent of leg and foot amputations in Canada. The number of leg and foot amputations is on the rise, according to a new study by researchers at ICES, a non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues.

The study published today in the CMAJ looked at data on all individuals at least 40-years-old with a history of diabetes and/or peripheral artery disease who underwent lower limb amputation between April 1, 2005 and March 31, 2016 in Ontario.

The researchers found that 20,062 patients with diabetes and/or peripheral artery disease had a lower limb amputation. Nearly two-thirds of those amputations (12,786 or 63.7 per cent) were major (above ankle) amputation. 

“Our study suggests that we need to renew and better coordinate efforts to prevent amputations related to diabetes and poor circulation,” says Dr. Charles de Mestral, senior author on the study, adjunct scientist at ICES and vascular surgeon at St. Michael's Hospital.

The researchers found that overall rates of amputations have increased over the last decade, driven by a rise in minor amputations (below the ankle) which is line with the growing number of people diagnosed with diabetes in Ontario. 

“The rising prevalence of diabetes, peripheral artery disease, and the aging population are some factors that may help explain why we found a rise in the number of amputations over the study period,” says Dr. Mohamad A. Hussain, lead author of the study, vascular surgery resident at the University of Toronto.

The overall rate of any (major or minor) amputation initially declined from a quarterly rate of 9.88 per 100,000 individuals down to 8.62 between 2005 and 2010, but increased again by 2016 to 10 per 100,000 individuals.

“For people with diabetes, lower-limb amputation is considered to be one of the most feared and debilitating consequences of the disease,” says Dr. Jan Hux, president and CEO of Diabetes Canada. “The growing rates for diabetic foot complications are driven by a complex set of factors including prevalence, suboptimal treatments and barriers patients face in accessing necessary resources, including foot care support. An integrated diabetes strategy is a solution that will work to reduce the burden of complications for people affected by the disease.”

Author block: Hussain MA, Al-Omran M, Salata K, Sivaswamy A, Forbes TL, Sattar N, Aljabri B, Kayssi A, Verma S, de Mestral C.

The article “Population-based secular trends in lower extremity amputation for diabetes and peripheral artery disease,” is in the September 3, 2019 issue of CMAJ.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario

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