TY - JOUR
T1 - Global trends in the incidence of hospital admissions for diabetes-related foot disease and amputations
T2 - a review of national rates in the 21st century
AU - Lazzarini, Peter A.
AU - Cramb, Susanna M.
AU - Golledge, Jonathan
AU - Morton, Jedidiah I.
AU - Magliano, Dianna J.
AU - Van Netten, Jaap J.
N1 - Funding Information:
All data generated or analysed during this study are included in this published article (and its supplementary information files). PAL and JJvN declare that they are members of the International Working Group on the Diabetic Foot (IWGDF) working groups and editorial board, respectively, which are responsible for authoring international evidence-based guidelines on DFD management. The authors declare that there are no other relationships or activities that might bias, or be perceived to bias, their work. PAL contributed to the conception and design of the study, literature search, data extraction, analyses and interpretation of data and drafted the manuscript. SMC contributed to the study design, data extraction, analyses and interpretation of data and revised the manuscript critically for important intellectual content. JG, JIM and DJM contributed to the study design, analyses and interpretation of data and revised the manuscript critically for important intellectual content. JJvN contributed to the conception and design of the study, analyses and interpretation of data and revised the manuscript critically for important intellectual content. All authors reviewed and approved the final version of the manuscript. PAL is responsible for the integrity of the work as a whole and is also the guarantor of this work.
Funding Information:
Work in the authors’ groups is supported by various funding sources, including an Australian National Health and Medical Research Council (NHMRC) Fellowship Grant (#1143435) to PAL; an NHMRC Investigator Grant (#2008313) to SMC; NHMRC, Australian Heart Foundation, Medical Research Futures Fund and Queensland Government grants to JG; an Australian Government Research Training Program grant and a Monash Graduate Excellence Scholarship to JIM; an Alice Baker and Eleanor Shaw Gender Equity Fellowship to DJM; and grants from the Netherlands Organisation for Health Research and Development (ZonMw) to JJvN. However, the authors declare that these funding sources had no role in the development of this manuscript.
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2023/2
Y1 - 2023/2
N2 - Aims/hypothesis: Diabetic foot disease (DFD) is a leading cause of hospital admissions and amputations. Global trends in diabetes-related amputations have been previously reviewed, but trends in hospital admissions for multiple other DFD conditions have not. This review analysed the published incidence of hospital admissions for DFD conditions (ulceration, infection, peripheral artery disease [PAD], neuropathy) and diabetes-related amputations (minor and major) in nationally representative populations. Methods: PubMed and Embase were searched for peer-reviewed publications between 1 January 2001 and 5 May 2022 using the terms ‘diabetes’, ‘DFD’, ‘amputation’, ‘incidence’ and ‘nation’. Search results were screened and publications reporting the incidence of hospital admissions for a DFD condition or a diabetes-related amputation among a population representative of a country were included. Key data were extracted from included publications and initial rates, end rates and relative trends over time summarised using medians (ranges). Results: Of 2527 publications identified, 71 met the eligibility criteria, reporting admission rates for 27 countries (93% high-income countries). Of the included publications, 14 reported on DFD and 66 reported on amputation (nine reported both). The median (range) incidence of admissions per 1000 person-years with diabetes was 16.3 (8.4–36.6) for DFD conditions (5.1 [1.3–7.6] for ulceration; 5.6 [3.8–9.0] for infection; 2.5 [0.9–3.1] for PAD) and 3.1 (1.4–10.3) for amputations (1.2 [0.2–4.2] for major; 1.6 [0.3–4.3] for minor). The proportions of the reported populations with decreasing, stable and increasing admission trends were 80%, 20% and 0% for DFD conditions (50%, 0% and 50% for ulceration; 50%, 17% and 33% for infection; 67%, 0% and 33% for PAD) and 80%, 7% and 13% for amputations (80%, 17% and 3% for major; 52%, 15% and 33% for minor), respectively. Conclusions/interpretation: 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. Registration: This review was registered in the Open Science Framework database (https://doi.org/10.17605/OSF.IO/4TZFJ). Graphical abstract: [Figure not available: see fulltext.]
AB - Aims/hypothesis: Diabetic foot disease (DFD) is a leading cause of hospital admissions and amputations. Global trends in diabetes-related amputations have been previously reviewed, but trends in hospital admissions for multiple other DFD conditions have not. This review analysed the published incidence of hospital admissions for DFD conditions (ulceration, infection, peripheral artery disease [PAD], neuropathy) and diabetes-related amputations (minor and major) in nationally representative populations. Methods: PubMed and Embase were searched for peer-reviewed publications between 1 January 2001 and 5 May 2022 using the terms ‘diabetes’, ‘DFD’, ‘amputation’, ‘incidence’ and ‘nation’. Search results were screened and publications reporting the incidence of hospital admissions for a DFD condition or a diabetes-related amputation among a population representative of a country were included. Key data were extracted from included publications and initial rates, end rates and relative trends over time summarised using medians (ranges). Results: Of 2527 publications identified, 71 met the eligibility criteria, reporting admission rates for 27 countries (93% high-income countries). Of the included publications, 14 reported on DFD and 66 reported on amputation (nine reported both). The median (range) incidence of admissions per 1000 person-years with diabetes was 16.3 (8.4–36.6) for DFD conditions (5.1 [1.3–7.6] for ulceration; 5.6 [3.8–9.0] for infection; 2.5 [0.9–3.1] for PAD) and 3.1 (1.4–10.3) for amputations (1.2 [0.2–4.2] for major; 1.6 [0.3–4.3] for minor). The proportions of the reported populations with decreasing, stable and increasing admission trends were 80%, 20% and 0% for DFD conditions (50%, 0% and 50% for ulceration; 50%, 17% and 33% for infection; 67%, 0% and 33% for PAD) and 80%, 7% and 13% for amputations (80%, 17% and 3% for major; 52%, 15% and 33% for minor), respectively. Conclusions/interpretation: 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. Registration: This review was registered in the Open Science Framework database (https://doi.org/10.17605/OSF.IO/4TZFJ). Graphical abstract: [Figure not available: see fulltext.]
KW - Admissions
KW - Amputations
KW - Diabetes complications
KW - Diabetes mellitus
KW - Diabetic foot
KW - Diabetic foot disease
KW - Diabetic foot ulcer
KW - Epidemiology
KW - Hospitalisations
KW - Review
UR - http://www.scopus.com/inward/record.url?scp=85143888131&partnerID=8YFLogxK
U2 - 10.1007/s00125-022-05845-9
DO - 10.1007/s00125-022-05845-9
M3 - Review Article
C2 - 36512083
AN - SCOPUS:85143888131
SN - 0012-186X
VL - 66
SP - 267
EP - 287
JO - Diabetologia
JF - Diabetologia
IS - 2
ER -