amputation in type 2 diabetic patients in dutch primary health care

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1、Pathophysiology/ComplicationsORIGINALARTICLEFootUlcerationandLowerLimbAmputationinType2DiabeticPatientsinDutchPrimaryHealthCare11ILONASTATIUSMULLER,MDMARIELOUISEBARTELINK,MD,PHDinprimaryhealthcare(49).A14-year22WIMJ.C.DEGRAUW,MD,PHDHENKJ.M.VANDENHOOGENincidenceoflowerlimbamput

2、ationof21WILLEMH.E.M.VANGERWENGUYE.H.M.RUTTEN,MD,PHD9.9%isreportedinprimarycare(10).Dutchstudiesreportthattheprevalenceofulcerationis1.8%(11,12).Nothingisknownaboutitsincidence.Theage-adjustedincidenceofamputationintheOBJECTIVETodeterminetheincidenceoffootulcerationandlowerlim

3、bamputationinNetherlandsisestimatedtobe35.1pertype2diabeticpatientsinprimaryhealthcare.10,000diabeticmalesand17.4per10,000diabeticfemales(13).InprimaryRESEARCHDESIGNANDMETHODSDataontype2diabeteswerecollectedbythehealthcareintheNetherlands,itisesti-NijmegenMonitoringProjectbetw

4、een1993and1998aspartofastudyofchronicdiseases.Therecordsofallpatientsrecordedashavingdiabeticfootproblemsandthosewhodied,movedtomatedthat13%ofdiabeticpatientsareatanursinghome,orwereunderspecialistcarewereincluded.Theannualincidenceoffootriskfordevelopingfootproblems(11).ulcer

5、ationwasdefinedasthenumberoftype2diabeticpatientsperpatient-yearwhodevelopedThemostimportantinterventiontopre-anewfootulcer.Incidenceoflowerlimbamputationwassimilarlydefined.Additionalinfor-ventfootulcerationanditsconsequencesmationwascollectedontreatmentoffootulcers.isearlyreco

6、gnitionofhigh-riskpatientsandreferraltoappropriatemultidisci-RESULTSThestudypopulationoftype2diabeticpatientsincreasedfrom511patient-plinaryteams(1417).Highriskcanbeyearsin1993to665in1998.Theannualincidenceoffootulcerationvariedbetween1.2anddetectedfromthehistoryofaprevious3.0

7、%(mean2.1)peryear;25%ofthepatientshadrecurrentepisodes.Theannualincidenceofulcer/amputationandclinicalexamina-lowerlimbamputationvariedbetween0.5and0.8%(mean0.6).Tenofthe15amputeesdied,tion;forexample,impairedmonofila-and12of52(23%)patientswithulcerationhadasubsequentamputation

8、oraprevioushistoryofamputation.In35ofthe73(48%)episodesofulce