Patients with diabetes are at increased risk for lower-extremity amputation, but younger patients as well as women are at greatest risk of nontraumatic lower-extremity amputation, based on a review of medical records of 500,868 patients with diabetes and a matched group of controls (Diabetes Care. 2006; 29:2409-2414). As expected, compared with ag and sex-matched controls, patients with diabetes were at significantly higher risk for nontraumatic foot amputation compared with controls.

During 6 years of follow-up, the estimated incidence rates of nontraumatic foot amputation and nontraumatic peripheral revascularization procedure were 410.3 and 115.2 per 100,000 patient-years in men with diabetes, respectively, and 317.0 and 86.0 per 100,000 patient-years in women with diabetes, respectively.

But Cox proportional hazard regression that adjusted for age, sex, geographic area, and urbanization status showed that relative risks for amputation were 9.22 in men versus 11.67 in women. For both men and women, the risk for amputation was highest at age 45 to 54 years, but the relative risk in women was almost twice as high (27.92) as in men (14.40) in this age-group. The contribution of age and gender to risk for peripheral revascularization procedure was less apparent.