The 25-year cumulative incidence of lower extremity amputations in people with type 1 diabetes. Diabetes Care 2011;34:649–651

OBJECTIVE—To examine the 25-year cumulative incidence of lower-extremity amputation (LEA) in people with type 1 diabetes. RESEARCH DESIGN ANDMETHODS—Cumulative incidence of LEA was ascertained in Wisconsin Epidemiologic Study of Diabetic Retinopathy participants (n = 943) using the Kaplan-Meier approach accounting for competing risk of death. Relationships of baseline char-acteristics with incidence of LEA were explored using a proportional hazards approach with discrete linear regression modeling. RESULTS—The overall 25-year incidence of LEA was 10.1%. In multivariate analyses (results reported as odds ratio; 95%CI), beingmale (3.90; 2.29–6.65), heavy smoking (2.07; 1.11–3.85), having hypertension (3.36; 1.91–5.93), diabetic retinopathy (2.62; 1.13–6.09), neuropathy (1.68; 1.02–2.76), and higher HbA1c (per 1 % 1.40; 1.24–1.58) were independently associated with the incidence of LEA. CONCLUSIONS—Our results show a high 25-year incidence of LEA and suggest that gly-cemic control and blood pressure control and preventing heavy smoking may result in reduction in its incidence. Diabetes Care 34:649–651, 2011 Several studies have described theincidence of lower-extremity ampu-tation (LEA) and its relationship to various risk factors such as glycemia and blood pressure (1–5), but few have stud-ied cohorts of people with type 1 diabetes followed over a long period (1–4). De-spite changes in care, the incidence of LEA remains high, at 0.15–0.36 % per 10,000 people (2,3,5). In this study, we examine the 25-year cumulative inci-dence of LEA in a large cohort with type 1 diabetes participating in the Wisconsi