In this study , the ADA used data from two nationally representative surveys to assess trends in NLEA hospital discharge rates by patients ’ diabetes status and to determine whether disparities in NLEA rates within the diabetic population persist . These national surveys offered information for short-stays in nonfederal hospitals in all 50 states and the District of Columbia that collected discharge data . Also using NLEA discharge codes and diagnosis codes the ADA defined their core study groups eliminating those patients who received amputations after a traumatic injury . The studies primary focus was on those diagnostic and discharge codes that listed patients with NLEA diabetic and standard diabetic related issues .
RESULTS : The ADA findings discovered that although the number of U . S . residents with diagnosed diabetes increased dramatically from 5.4 million in 1988 to 17.1 million in 2008 , the estimated number of diabetes-related NLEA discharge codes increased from 52,868 in 1988 to 83,153 in 1996 and then decreased to 70,139 in 2008 . Among people with diabetes , NLEA rates were highest among those older than 75 years of age and was lowest among people aged 40-64 years of age throughout most of the 20 year period analyzed . NLEA rates decreased in 1996 in all age groups , although APC from 1996 to 2008 increased significantly in those older than 75 years of age then those in the 40 to 64 years of age group or the 65 to 74 years of age . Overall , between 1996 and 2008 Nontraumatic Lower Extremity Amputations rates decreased by 67 %.
The ADA conclusion to their study shows a substantial decrease in NLEA rates in the U . S diabetic population which is consistent with earlier studies of diabetics in U . S . patient groups served by Medicare and veterans served by the Veterans Health Administration , along with studies done in Finland and England as well . Based on the national representation used , and the adjustments the ADA used for NLEA rates in the diabetic population , the 2008 NLEA rate was 8 times higher in the diabetic population , indicating a need for additional efforts to further reduce the excessive risk for NLEA among persons with diabetes .
It is also important to note in this study that in the U . S . the revelance of cardiovascular risk factors has declined and the rate of preventive care practices , including self-management training for people with diabetes , have improved significantly . The data also shows a decline in hospitalizations for peripheral arterial disease and ulcer inflammation , precursor conditions for NLEA , which leads the ADA to suggest improvements in recognizing and managing high-risk feet among diabetic patients . Medicare ’ s Therapeutic Shoes for Diabetics benefit was created in 1993 to reduce the instances of ulcerations and ultimately NLEAs and one could conclude from this study , has shown its effectiveness .
To further decrease NLEA rates , pedorthic practitioners in all communities need to continue spreading awareness of diabetes and its complications , as well as create interventions to reduce the growing risk factors for NLEA and to improve foot care and overall care for people with diabetes .
To obtain a full copy of this study , contact the American Diabetes Association and request a copy of their study results , “ Declining Rates of Hospitalization for Nontraumatic Lower- Extremity Amputation in the Diabetic Population Aged 40 years or Older ; U . S . 1988 2009 ” from their February 1,2012 Diabetes Care Booklet , Volume 35 , Number 2 . ■
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