Incidentie van voetulcera en amputaties bij diabetes-mellitus-type-2-patiënten in de huisartspraktijk, regio Nijmegen 1993-1998

Objective. To determine the incidence of foot ulceration and lower-limb amputations in type-2 diabetes patients in primary health care. Design. Cohort study. Method. Data were used from the prospective Nijmegen monitoring project (1993-1998) carried out in 10 general practices (26 general practitioners, 45,500 patients). The records of all diabetes patients with diabetic foot problems, who had died, had moved or were under specialist care, were completed retrospectively. The incidence of diabetic foot ulcers and amputations was determined. Results. The study population of type-2 diabetes patients increased from 511 patient-years in 1993 to 665 patient-years in 1998. The annual incidence of foot ulceration was 1.2-3.0% (mean: 2.1%); 25% of the patients had recurrent episodes. The annual incidence of amputation was 0.5-0.8% (mean: 0.6%). Twelve of the 15 patients (80%) who underwent an amputation had an infected or necrotic foot ulcer prior to this. Ten of the 15 amputees died. Of the 52 patients with a foot ulcer, 10 underwent an amputation and 2 had previously undergone an amputation. Patients with foot problems were older than patients without foot problems and had more cardiovascular disease, retinopathy and absent peripheral pulsations. Conclusion. The annual incidence of foot ulceration and lower limb amputation in type-2 diabetes patients was several percent. Recurrent foot ulceration occurred in one quarter of the patients and this was a risk factor for amputation; amputation was associated with a high level of mortality.