Trends in Nontraumatic Lower-Extremity Amputation Among Privately Insured Adults With Diabetes in the U.S., 2004-2018.

Estimates based on the National Inpatient Sample (NIS) showed that diabetes-related nontraumatic lower- extremity amputation (NLEA) rates declined among hospitalized patients between 2000 and 2009, followed by an increasing NLEA rate between 2009 and 2015 (1). The increase was largely observed in young and middle-aged adults (1). However, the NIS dataset includes only inpatient admissions; minor amputation surgeries that were performed in ambulatory settings were not included in these estimates. In addition, NIS data are event-based, and multiple amputations in the same person are considered as a new event each time. In the current study, we used the IBM MarketScan Commercial Database to examine NLEA occurring in inpatient and outpatient settings among privately insured adults 18–64 years of age with diabetes. The study period is from 2004 to 2018. People with diabetes and NLEA were identified using the International Classification of Diseases and the Current Procedural Terminology codes. NLEAs were categorized as major (amputations above the foot) or minor (foot and toe amputations) (1). For people who had multiple amputations in a year, we assigned the level of amputation based on the highest level …