Temporal trends in the rates of foot complications and lower-extremity amputation related to type 1 and 2 diabetes in adults in selected Canadian provinces.

Purpose: To determine the contemporary annual incidence rates of hospitalization for diabetes-related foot complication (DFC) and lower-extremity amputation in Canada.

Methods: The study timeframe was April 2011 to March 2022. The population was persons at least 20 years old in all of Canada except Québec. From the Canadian Institute for Health Information's Discharge Abstract Database of acute care hospitalizations, a person's (i) first DFC, (ii) first diabetes-related major amputation, and (iii) first diabetes-related major or minor amputation were identified. Using population data from Statistics Canada, age- and sex-adjusted annual rates were calculated for each of these events. Regression models for temporal trends in these rates were fitted for the full population and by province or territory.

Results: Over the 11-year study period, there were 20,886 first major amputations, 41,643 first major or minor amputations, and 48,526 first DFC. The average incidence rates across years for major amputation, major or minor amputation, and DFC were 8.8, 17.5, and 20.3 per 100,000 population respectively. The major amputation rate decreased over time (-0.06 per year [95% CI -0.11 to -0.01]), but there was no change over time for other events. A declining rate of major amputation was only observed in Ontario, Manitoba, and Saskatchewan, but not in other provinces or territories.

Conclusion: The national rate of major amputation related to diabetes has decreased, but the burden of DFC requiring hospitalization has not. These contemporary data support the need to strengthen foot screening and limb preservation efforts for people living with diabetes across Canada.