Incidence of lower limb amputations in individuals with and without diabetes mellitus in Andalusia (Spain) from 1998 to 2006 Maria Cruz Almaraz a,b,e, *, Stella Gonza ´ lez-Romero a,b,e , Manuel Bravo a,c , Fe ´lix Francisco Caballero d , Maria Jose ´ Palomo a,b , Rosario Vallejo a,b , Isabel Esteva b,e , Fernando Calleja a,f , Federico Soriguer a,b,e a Diabetic Foot Unit, Carlos Haya University Hospital, Malaga, Spain b Endocrinology and Nutrition Department, Carlos Haya University Hospital, Malaga, Spain c Orthopedics Department, Carlos Haya University Hospital, Malaga, Spain d Department of Personality, Evaluation and Psychological Treatment, School of Psychology, University of Malaga, Spain e Ciber of Diabetes and Related Metabolic Diseases (CIBERDEM) f Department of Vascular Surgery, Carlos Haya University Hospital, Malaga, Spain 1. Introduction Diabetes mellitus is one of the main underlying conditions for LLA, after excluding traumas and tumors. Although some differences exist in the rates of LLA among countries and ethnic groups, studies usually come to the conclusion that around half of all LLA occur in patients with diabetes mellitus [1–6]. Additionally, ipsilateral reamputation at a higher level or d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 9 5 ( 2 0 1 2 ) 3 9 9 – 4 0 5 a r t i c l e i n f o Article history: Received 10 August 2011 Received in revised form 15 October 2011 Accepted 24 October 2011 Published on line 30 November 2011 Keywords: Amputations Diabetic foot Diabetes Epidemiology a b s t r a c t Aims: We studied the changes in the incidence of lower limb amputation (LLA) in Andalusia from 1998 to 2006 in the population with and without diabetes. Methods: We undertook a retrospective study of all LLA performed in Andalusia in people aged 30 years old, with or without diabetes, between 1 January 1998 and 31 December 2006. We obtained the crude and standardized incidence rates by year, and sex for three periods: 1998–2000, 2001–2003 and 2004–2006 and calculated the RR of requiring LLA in patients with diabetes. To test for time trend, Poisson regression models were fitted. Results: A total of 16,210 LLA were carried out in Andalusia, 72.6% in patients with diabetes mellitus and 66.4% in men. In the population with diabetes the standardized incidence of all LLA was found to be 344.0 per 100,000 (95% CI, 315.4–372.4) in 2004–2006. There was an estimated incidence increase for all LLA by 14% and for minor LLA by 13.6% in 2004–2006. In people with diabetes the RR increased by 31.6% as compared to the first period. Conclusions: Despite the implementation of a care plan for patients with diabetes, the incidence of LLA has not fallen in Andalusia in recent years. # 2011 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Endocrinology and Nutrition Department, Carlos Haya University Hospital, Plaza del Hospital Civil s/n, 29009 Malaga, Spain. Tel.: +34 952286704; fax: +34 952286704. E-mail addresses: malmaraza@hotmail.com (M.C. Almaraz), stellagr@telefonica.net (S. Gonza ´ lez-Romero), mbravob2001@yahoo.es (M. Bravo), ffcaballero23@hotmail.com (F.F. Caballero), mariajosepalomofdez@hotmail.com (M.J. Palomo), rosariovallejomora@hotmail.com (R. Vallejo), miesteva@wanadoo.es (I. Esteva), fkyeja@terra.es (F. Calleja), federico.soriguer.sspa@juntadeandalucia.es (F. Soriguer). Contents available at Sciverse ScienceDirect Diabetes Research and Clinical Practice journal homepage: www.elsevier.com/locate/diabres 0168-8227/$ – see front matter # 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.diabres.2011.10.035