Lower-Extremity Amputation Trends Among People With Diabetes in a Large Urban Environment

Nontraumatic lower-extremity amputations (NLEAs) are a disabling and costly complication of uncontrolled diabetes (1). Factors influencing NLEAs include glycemic control, vascular disease, foot ulcer, and diabetes prevention practices (2,3). Texas has high rates of underinsured individuals, high prevalence of diabetes, a growing Hispanic population, and high rates of NLEAs (4). We examine trends of lower-extremity amputation rates among adults with diabetes in Dallas County between 2015 and 2019. Using data from the Dallas-Fort Worth Hospital Council Educational and Research Foundation (DFWHC) and the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System (BRFSS), we calculated age-adjusted rates for major, minor, and overall NLEAs between 1 October 2015 and 30 September 2019. We followed the methodology used by Geiss et al. (3) and calculated age-adjusted NLEA rates per 1,000 adults with diabetes, using four adult age categories, with denominator data (numbers of adults with diabetes) estimated using BRFSS Dallas County diabetes prevalence data. Because of the transition of the ICD-9 to ICD-10 coding system on 1 October 2015, the 2015 quarter 4 data were annualized to account for quarters 1–3 that were coded using the prior ICD-9 system and therefore not used. The 2019 data were annualized to …