LEA incidence and better organized foot care Diabetes and Non-diabetes Related Lower Extremity Amputation Incidence Before and After the Introduction of Better Organized Diabetes Foot Care. Continuous longitudinal monitoring using a standard method

Objective: There is a lack of continuous longitudinal population based lower extremity amputation (LEA) data in the UK. We present here accurate data on trends in diabetes related (DR)LEAs and non-DRLEAs in the South Tees area over a continuous 5 year period. Research Design and Methods: All cases of LEA from 1 July 1995 to 30 June 2000 within the area were identified. Estimated ascertainment using capture-recapture analysis approached 100% for LEAs in the area. Data was collected longitudinally using the standard method of the Global Lower Extremity Amputation Study protocol. Results: Over 5 years there were 454 LEAs (66.3% male) in the South Tees area, of which 223 were diabetes related (49.1%). Among persons with diabetes LEA rates went from 564.3 in the 1 year to 176.0 per 100,000 persons with diabetes in the 5 year. Over the same period non-DRLEAs increased from 12.3 to 22.8 per 100,000 persons without diabetes. The relative risk of a person with diabetes undergoing an LEA went from being 46 times that of a person without diabetes to 7.7 at the end of the 5 years. The biggest improvement in LEA incidence was seen in the reduction of repeat major DRLEAs. Conclusion: Our data shows that in the South Tees area at a time when major non-DRLEA rates increased major DRLEA rates have fallen. These diverging trends mark a significant improvement in care for patients with diabetic foot disease as a result of better organized diabetes care.