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High quality primary care and achievement of key quality targets lowers the risk of amputations in people with type 2 diabetes

Lower limb amputations are an important and largely preventable complication of type 2 diabetes mellitus that impact considerably on the life expectancy and quality of life of those affected. In England, more than 9000 diabetes-related amputations are performed each year, with decreasing rates but higher absolute numbers of major amputations, and the annual direct healthcare costs of diabetic foot ulceration and amputation are approximately £1 billion. 

In an article published in BMJ Open Diabetes Research & Care, we investigated the associations between attainment of primary care quality clinical indicators, completion of National Diabetes Audit care processes, and non-traumatic lower limb amputations among people with type 2 diabetes. We observed that minor or major, as well as major-only, amputation rates were 26%–51% and 3%–51%, respectively, lower among those who met the HbA1c indicator and 14%–47% lower among those who met the cholesterol indicator for our primary outcome. 

Comprehensive primary care-based secondary prevention may offer considerable protection against diabetes-related amputation. This has important implications for diabetes management and medical decision-making for patients, as well as type 2 diabetes quality improvement programs.

DOI: http://dx.doi.org/10.1136/bmjdrc-2020-002069

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