Trends in Peripheral Artery Disease, Lower Extremity Revascularization, and Lower Extremity Amputation in Incident Type 2 Diabetes: A Danish Population-Based Cohort Study

Objective: To examine trends in peripheral artery disease (PAD), lower extremity (LE) revascularization, and LE amputation in patients with incident type 2 diabetes.

Research Design and Methods: This cohort study included patients in Denmark diagnosed with type 2 diabetes in 1996–2015 and followed until 2020. Patients were age- and sex-matched with as many as three general population individuals. Outcomes comprised 5-year cumulative incidences of first-time PAD, LE revascularization, and LE amputation. Age- and sex-adjusted hazard ratios (aHRs) were computed with Cox regression.

Results: The cohort comprised 349,454 patients with incident type 2 diabetes (53% male; median age 62 years) and 1,025,054 general population individuals. Among patients with diabetes, decreases in 5-year cumulative incidence of PAD (from 6.2% to 3.4%; aHR 0.55 [95% CI 0.52–0.57]), LE revascularization (from 0.8% to 0.6%; aHR 0.80 [95% CI 0.71–0.90]), and LE amputation (from 1.0% to 0.4%; aHR 0.45 [95% CI 0.40–0.51]) occurred from 1996–2000 to 2011–2015. LE amputation decreased at all amputation levels (hip/thigh, knee/lower leg, and ankle/foot/toe amputation) during the study period. In the general population, 5-year cumulative incidence remained stable (1.2–1.5% for PAD, ~0.4% for LE revascularization, and ~0.2% for LE amputation). However, the relative rates of all outcomes were two- to three-fold higher in patients with diabetes than matched individuals in 2011–2015.

Conclusions: In recent decades, the cumulative incidence of LE complications substantially decreased in patients with incident type 2 diabetes while remaining stable in the general population.