Feet

One aim of St Vincent Declaration is to reduce amputations in people with diabetes by SO'!.. We studied all non-traumatic lower-limb amputations in a District General Hospital between Jan. 1993 Dec. 1993 and from Jan. 1995 Dec. 1997, a total period of five years. Of 136 non-traumatic lower-limb amputations in this period, 62 (46%) were in people with diabetes; 1993: 17/36(47"/e); 1995: 15/35 (43%); 1996: 19/31 (61%); 1997: 11134 (32%)respectively, trend p=Q.I. In the 3 years 1995-1997, 15/45 (33%) were foot amputations; 19/45 (42%) were belowknee and 11/45 (25%) were above-knee. Primary indication for amputation wu peripheral vucular disease in 62%, uncontrolled infection and ulcers in 31% and others in 7% of patients. Thirtyfour patients (76%) had known Type II diabetes, of whom 18% were on diet, 68% on oral hypoglycaemics and 14% on insulin. Mortality upto Dcc.l998 wu 53%; 42% and 45% for 1995, 1996 and 1997 respectively and wu higher than that in the non-diabetic amputees, 21/45 (47%) versus 12/55 (:Wie), p-0.09 between 1995-1997. The impact of recent change• in clinical care and the estlbli•hment of a dedicated diabetic foot ICIVice have yet to be evaluated. Thete data sugsests little evidence of a UK-wide-trend towards reduced amputations amongst people with diabetes and suggest that improvements demonstrated elsewhere may be the result of specific interventions.