Diabetes complications

Global trends in the incidence of hospital admissions for diabetes-related foot disease and amputations: a review of national rates in the 21st century

DiabetologiaPublished Systematic review

Authors' conclusion

These findings suggest that hospital admission rates for all DFD conditions are considerably higher than those for amputations alone and, thus, the more common practice of reporting admission rates only for amputations may substantially underestimate the burden of DFD. While major amputation rates appear to be largely decreasing, this is not the case for hospital admissions for DFD conditions or minor amputation in many populations. However, true global conclusions are limited because of a lack of consistent definitions used to identify admission rates for DFD conditions and amputations, alongside a lack of data from low- and middle-income countries. We recommend that these areas are addressed in future studies.

Study context

Population
Nationally representative populations with diabetes; publications reporting incidence of hospital admissions for diabetic foot disease (DFD) conditions (ulceration, infection, PAD, neuropathy) or diabetes-related amputations (minor and major), PubMed and Embase, 1 January 2001–5 May 202271 publications · 27 countries
Outcome
Incidence of hospital admissions for DFD conditions and diabetes-related amputations, and relative trends over time
Methodological detailsnationally representative populations, 2527 publications identified; 71 eligible (14 on DFD, 66 on amputation, nine both); 93% high-income countries
  • Nationally representative populations
  • 2527 publications identified; 71 eligible (14 on DFD, 66 on amputation, nine both); 93% high-income countries

Pooled result

As reported in the abstract

Median (range) incidence of admissions per 1000 person-years with diabetes
DFD conditions
16.3 (8.4-36.6)
Ulceration
5.1 [1.3-7.6]
Infection
5.6 [3.8-9.0]
PAD
2.5 [0.9-3.1]
Amputations
3.1 (1.4-10.3)
Major amputation
1.2 [0.2-4.2]
Minor amputation
1.6 [0.3-4.3]

Further pooled results

Proportion of reported populations with decreasing, stable and increasing admission trends

DFD conditions (decreasing, stable, increasing)
80%, 20% and 0%
Ulceration
50%, 0% and 50%
Infection
50%, 17% and 33%
PAD
67%, 0% and 33%
Amputations
80%, 7% and 13%
Major amputation
80%, 17% and 3%
Minor amputation
52%, 15% and 33%

Original publication

Global trends in the incidence of hospital admissions for diabetes-related foot disease and amputations: a review of national rates in the 21st century. Diabetologia. Published 13 December 2022. doi:10.1007/s00125-022-05845-9

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