K Winell1, M Venermo, T Ikonen, R Sund. 1. THL - National Institute for Health and Welfare, Helsinki, Finland. Electronic address: klas.winell@conmedic.fi.
Abstract
OBJECTIVE: To test various indicators for comparing the outcomes of diabetic foot care. DESIGN: All 396,317 patients treated with hypoglycaemic medication in Finland were followed up based on nationwide registers on hospital discharges and causes of death during 1997-2007. MATERIALS AND METHODS: The crude and standardized incidences of lower extremity amputations (LEAs), the minor-major ratio of the first LEA and 2-year survival with a preserved leg after the first minor LEA were used as indicators for regional and temporal variation in diabetic foot care. RESULTS: A total of 13,469 LEAs were recorded in 1997-2007. The standardized population-corrected rate of first major LEA per 100,000 person-years declined from 10.0 (95% CI 9.6-10.5) to 7.3 (6.9-7.6) (p < .001), while the minor-major LEA ratio progressed from 0.86 (0.80-0.92) to 1.35 (1.26-1.46) (p < .001). By using these indicators, variation was observed between the university hospital catchment areas. Nationwide, the 2-year survival with a preserved leg after the first minor LEA increased statistically insignificantly from 50.8% (47.3-54.6%) to 55.4% (51.9-59.0%) (p = .08). CONCLUSIONS: The standardized, population-corrected incidence of major LEA, the minor-major LEA ratio, and major-amputation-free survival proved useful as indicators in comparing the outcomes of diabetic foot care.
OBJECTIVE: To test various indicators for comparing the outcomes of diabetic foot care. DESIGN: All 396,317 patients treated with hypoglycaemic medication in Finland were followed up based on nationwide registers on hospital discharges and causes of death during 1997-2007. MATERIALS AND METHODS: The crude and standardized incidences of lower extremity amputations (LEAs), the minor-major ratio of the first LEA and 2-year survival with a preserved leg after the first minor LEA were used as indicators for regional and temporal variation in diabetic foot care. RESULTS: A total of 13,469 LEAs were recorded in 1997-2007. The standardized population-corrected rate of first major LEA per 100,000 person-years declined from 10.0 (95% CI 9.6-10.5) to 7.3 (6.9-7.6) (p < .001), while the minor-major LEA ratio progressed from 0.86 (0.80-0.92) to 1.35 (1.26-1.46) (p < .001). By using these indicators, variation was observed between the university hospital catchment areas. Nationwide, the 2-year survival with a preserved leg after the first minor LEA increased statistically insignificantly from 50.8% (47.3-54.6%) to 55.4% (51.9-59.0%) (p = .08). CONCLUSIONS: The standardized, population-corrected incidence of major LEA, the minor-major LEA ratio, and major-amputation-free survival proved useful as indicators in comparing the outcomes of diabetic foot care.