Diabetes-Related Lower Extremity Amputation Epidemiology

Lower extremity amputation remains one of the most serious complications of diabetes, reflecting the combined effects of peripheral neuropathy, vascular disease and recurrent foot ulceration. Worldwide, the incidence of diabetes-related amputations varies widely, ranging from single‐digit rates per 100 000 population in well-resourced settings to several hundred per 100 000 in regions with limited access to multidisciplinary care. Over the past two decades many high-income countries have reported declines in major amputation rates, attributed to structured foot screening, rapid access to vascular and podiatry services, and education programmes. Conversely, many low- and middle-income regions continue to experience rising or stagnant rates, often linked to delayed presentation, scarce resources and a growing diabetes burden. Major amputations (above or below knee) carry a heavy toll of disability and mortality, while minor amputations (toe or partial foot) serve as both a marker of advanced disease and an opportunity for limb-salvage strategies. Key drivers of amputation risk include poor glycaemic control, peripheral arterial disease, sensory neuropathy, infection and socioeconomic barriers to early intervention. Accurate epidemiological surveillance using standardised definitions and person-year denominators is crucial to guide prevention and resource allocation, with emphasis on integrating primary care screening, offloading technologies and timely revascularisation to reduce avoidable limb loss.

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Diabetes-Related Lower Extremity Amputation Epidemiology publication trend

The graph below shows the total number of articles in diabetes-related lower extremity amputation epidemiology across all publications each year (not limited to Nature Index journals).

Technical terms

Incidence rate: The number of new amputation events in a population during a specified period, often expressed per 100 000 person-years.

Minor amputation: Removal of parts of the foot distal to the ankle, such as toes or transmetatarsal levels, often aimed at preserving limb function.

Major amputation: Surgical removal of the limb at or above the ankle joint, including below-knee and above-knee amputations, associated with greater morbidity.

Peripheral neuropathy: Nerve damage in the limbs leading to loss of sensation, increasing risk of unnoticed injury and ulcer formation.

Peripheral arterial disease: Narrowing of limb arteries that impairs blood flow, contributing to tissue ischaemia and poor wound healing.

Person-years: A metric combining the number of individuals and the time each contributes to a study, used to standardise incidence comparisons.

References

1. Lower Extremity Amputation Rates in People With Diabetes Mellitus: A Retrospective Population Based Cohort Study in Zwolle Region, The Netherlands. European Journal of Vascular and Endovascular Surgery (2023).
2. Incidence of lower extremity amputations in the diabetic compared with the non-diabetic population: A systematic review. PLOS ONE (2017).
3. 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 Diabetologica (2016).
4. Incidence and determinants of diabetes-related lower limb amputations in Ghana, 2010–2015- a retrospective cohort study. BMC Endocrine Disorders (2019).
5. Amputations of Lower Limb in Subjects with Diabetes Mellitus: Reasons and 30‐Day Mortality. Journal of Diabetes Research (2021).