Trends in the epidemiology of diabetic foot and lower limb amputations in Russian Federation according to the Federal Diabetes Register (2013–2016)

BACKGROUND: The epidemiological study of diabetic foot (DF) is very important because of high risk lower limbs amputations in patients with diabetes mellitus (DM).

AIMS: The aim of the study was to evaluate the DF prevalence in adult patients with type 1 (T1) and 2 (T2) diabetes in Russian Federation for period 2013–16years.

METHODS: We have used the database of the Russian Federal Diabetes register, 81st regions included in the online register. Indicators were estimated per 10,000 adult DM patients (>18years).

RESULTS: In 2016, the prevalence of DF in RF was T1 4,7%, T2 1,9%, with marked interregional differences: 0,15–19,9%, 0,07–10,3%, respectively. The DF prevalence in RF decreased: T1 506,3→473,6, T2 214,60→194,8. The incidence of new DF cases/per year was stable in adults with T1: 20,8→20,4/; increased in T2 13.2→14.2. The mean age of DF diagnosis increased by 2years for both DM types. The average DM duration of DF determine increased T1 15.4→19.0years, T2 7.4→10.1years. Proportion of DF forms: neuropathic with trophic ulcer 41.6%, neuropathic form (Charcot's foot) 17.9%, the neuroischemic 28.3%, ischemic 12.2%, in T2: 41.6%, 7,4%, 32,4%, 18,5%, respectively. The amount of new cases of amputations/per year in dynamics: T1 10,5→12,4, T2 9,6→10,9, with marked interregional differences 0.13–2.9% in T1, 0.04-6.0% in T2. The mean DM duration before amputation increased in T1 18.4→21.3years, in T2 9.1→9.9. The average amputation age: T1 51.7years, T2 66.2years. There was marked decrease in proportion of major amputations: T1 43,6→37,0%, T2 52.2→45.5 by redistribution in one toe amputations T14,0→10.0%, in T22,8→ 9.1%.

CONCLUSIONS: The dynamic of new DF cases in adult patients in Russian Federation is stable at T1, in T2 tends to increase. The interregional differences in frequency of DF and amputations may be due to differences in the quality of specialized care, the lack or shortage of diabetic foot cabinets, treatment of patients with DF in general surgical practice in a number of regions, which is recognized as a less effective strategy. A positive fact that proportion of high amputations declines, DF develops in later age and longer diabetes duration, that may reflect the increasing effectiveness of preventive lower limbs in diabetes.

diabetes mellitus, the register of diabetes mellitus, diabetic foot, amputations

1. Holleman F. The St. Vincent declaration on the treatment of diabetes (revision number 9). 2014. doi: 10.14496/dia.8105473810.9

2. Larsson J, Agardh CD, Apelqvist J, Stenstrom A. Long-term prognosis after healed amputation in patients with diabetes. Clin Orthop Relat Res. 1998(350):149-158.

3. Hoffmann M, Kujath P, Flemming A, et al. Survival of diabetes patients with major amputation is comparable to malignant disease. Diab Vasc Dis Res. 2015;12(4):265-271. doi: 10.1177/1479164115579005

4. International Diabetes Federation. IDF Diabetes Atlas. 8th ed. Brussels: International Diabetes Federation; 2017.

5. Дедов И.И., Шестакова М.В., Майоров А.Ю. и др. Алгоритмы специализированной медицинской помощи больным сахарным диабетом / Под ред. Дедова И.И., Шестаковой М.В., Майорова А.Ю. – 8-й выпуск // Сахарный диабет. – 2017. – Т. 20. – №1S. – C. 1-121. [Dedov II, Shestakova MV, Mayorov AY, et al. Dedov II, Shestakova MV, Mayorov AY, editors. Standards of specialized diabetes care. 8th edition. Diabetes mellitus. 2017;20(1S):1-121. (In Russ.)] doi: 10.14341/DM20171S8

6. Результаты реализации подпрограммы «Сахарный диабет» Федеральной целевой программы «Предупреждение и борьба с социально значимыми заболеваниями 2007-2012 годы» / Под ред. Дедова И.И., Шестаковой М.В. – М.; 2012. [Dedov II, Shestakova MV, editors. Rezul'taty realizatsii podprogrammy "Sakharnyy diabet" Federal'noy tselevoy programmy "Preduprezhdenie i bor'ba s sotsial'no znachimymi zabolevaniyami 2007-2012 gody". Мoscow; 2012. (In Russ.)]

7. Дедов И.И., Шестакова М.В., Викулова О.К. Эпидемиология сахарного диабета в Российской Федерации: клинико-статистический анализ по данным Федерального регистра сахарного диабета // Сахарный диабет. – 2017. – T. 20. – №1. – C. 13-41. [Dedov II, Shestakova MV, Vikulova OK. Epidemiology of diabetes mellitus in Russian Federation: clinical and statistical report according to the federal diabetes registry. Diabetes mellitus. 2017;20(1):13-41. (In Russ.)] doi: 10.14341/DM8664

8. Скрининг осложнений сахарного диабета как метод оценки качества лечебной помощи больным, по результатам 5-летней деятельности научно-практического проекта «Мобильный Диабет-Центр» / Под ред. Сунцова Ю.И., Дедова И.И., Шестаковой М.В. – М.; 2008. [Suntsov YI, Dedov II, Shestakova MV, editors. Skrining oslozhneniy sakharnogo diabeta kak metod otsenki kachestva lechebnoy pomoshchi bol'nym, po rezul'tatam 5-letney deyatel'nosti nauchno-prakticheskogo proekta «Mobil'nyy Diabet-Tsentr». Мoscow; 2008. (In Russ.)]

9. Дедов И.И., Галстян Г.Р., Токмакова А.Ю. Синдром диабетической стопы. В кн.: Осложнения сахарного диабета, лечение и профилактика / Под ред. Дедова И.И., Шестаковой М.В. – М.: МИА; 2017. – С. 559-577. [Dedov II, Galstyan GR, Tokmakova AY. Sindrom diabeticheskoy stopy. In: Dedov II, Shestakova MV, editors. Oslozhneniya sakharnogo diabeta, lechenie i profilaktika. Moscow: MIA; 2017. p. 559-577. (In Russ.)]

10. Carinci F, Massi Benedetti M, Klazinga NS, Uccioli L. Lower extremity amputation rates in people with diabetes as an indicator of health systems performance. A critical appraisal of the data collection 2000–2011 by the Organization for Economic Cooperation and Development (OECD). Acta Diabetol. 2016;53(5):825-832. doi: 10.1007/s00592-016-0879-4

11. Moxey PW, Gogalniceanu P, Hinchliffe RJ, et al. Lower extremity amputations--a review of global variability in incidence. Diabet Med. 2011;28(10):1144-1153. doi: 10.1111/j.1464-5491.2011.03279.x

12. Winell K, Venermo M, Ikonen T, Sund R. Indicators for comparing the incidence of diabetic amputations: a nationwide population-based register study. Eur J Vasc Endovasc Surg. 2013;46(5):569-574. doi: 10.1016/j.ejvs.2013.07.010