The prevalence of diabetes mellitus is growing at epidemic proportions worldwide. Considering the steady increase of the diabetic population, the prevalence of diabetes-related complications will continue to rise. Foot disorders are a major source of morbidity and mortality and account for more hospital admissions than any other long-term complication of diabetes. Up to 20% of total expenditure on diabetes might be attributable to diabetic foot. The most costly and devastating end-point of diabetic foot problems is lower extremity amputation (LEA). Individuals with diabetes have a 15 to 40 increased fold risk of LEA when compared to the general population with approximately half of all persons undergoing nontraumatic amputations having a diagnosis of diabetes. Appropriate multidisciplinary care to diabetic foot disease has been shown to reduce the incidence of LEAs by up to 78%. In Europe, a reduction in LEAs related to diabetes of at least 50% within 5 years was a declared aim of the St. Vincent Declaration and the US Government has set a target of reduction of 40% by the year 2000. There are only very few population-based studies available on the incidence and temporal variations of nontraumatic LEAs in Europe. Standardised, population-based data on LEA associated with diabetes are urgently needed, if these targets are to be achieved. The purpose of our study is to use national hospital admission data from all NHS hospitals in England from 1996 to 2005 to 1. provide standardized, population-based data on LEA associated with type 1 and type 2 diabetes; 2. evaluate changes in LEA rates in people with and without diabetes; 3. examine diabetes-associated LEA rates by age, gender and social deprivation to identify populations at risk; 4. analyse length of hospital stay (LOS) associated with LEAs; 5. report perioperative and one-year mortality associated with LEAs between 2000 and 2005. Our study will have important financial and health planning implications.
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