Lower Extremity Amputation Rates From 2016 to 2021 in People With and Without Diabetes Mellitus in the Netherlands: DUDE-9, a Retrospective, Observational Study

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Objectives. This study aims to determine recent lower extremity amputation (LEA) rates in individuals with and without diabetes mellitus (DM) in the Netherlands. Design. This is a retrospective, observational study of LEAs based on all-payer claims database (APCD) data from 2016 to 2021. Methods. This study analyzes LEAs using an APCD covering over 99% of the Dutch population. It assesses LEA rates in individuals with and without diabetes (types 1 and 2), focusing on 2016, when preventive diabetic foot care was fully implemented. All individuals aged ≥18 years detected with an LEA through reimbursement claims were included in the analysis. Results. The total number of individuals with reimbursed LEAs per year ranged from 5030 (35.7 per 100,000 individuals) to 5260 (38.1 per 100,000). In individuals with DM, this ranged from 2907 to 3081 (290.9 to 312.6 per 100,000). The highest LEA prevalence was found in individuals with type 1 DM (T1DM) (606.1-732.4 per 100,000). In individuals without DM, the yearly LEA rates ranged between 16.3 and 17.8 per 100,000. Approximately two thirds of all individuals with LEA were male (ratios 1.9-2.3). Conclusion. Compared to earlier Dutch studies, major LEA incidence appears to be slightly fluctuating over time, without an increase in minor amputations. This contrasts with other countries, where increased minor amputation rates are observed. These data provide valuable insights into LEA rates and emphasize that individuals most at risk are those with T1DM. More detailed studies, including longitudinal and clinical data, are needed to further specify groups and individuals at risk. Levels of Evidence: Level III: Retrospective cohort study

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