A population-based study

OBJECTIVE — Complications occur in diabetes despite rigorous efforts to control risk fac-tors. Since 2000, the National Development Programme for the Prevention and Care of Diabetes has worked to halve the incidence of amputations in 10 years. Here we evaluate the impact of the efforts undertaken by analyzing the major amputations done in 1997–2007. RESEARCHDESIGNANDMETHODS — All individuals with diabetes (n 396,317) were identified from comprehensive national databases. Data on the first major amputations (n 9,481) performed for diabetic and nondiabetic individuals were obtained from the National Hospital Discharge Register. RESULTS — The relative risk for the first major amputation was 7.4 (95 % CI 7.2–7.7) among the diabetic versus the nondiabetic population. The standardized incidence of the first major amputation decreased among the diabetic and nondiabetic populations (48.8 and 25.2 % relative risk reduction, respectively) over 11 years, and the time from the registration of diabetes to the first major amputation was significantly longer, on average 1.2 years more. The cumulative five-year postamputation mortality among diabetic individuals was 78.7%. CONCLUSIONS — In our nationwide diabetes database, the duration from the registratio