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to: Jeffcoate WJ, van Houtum WH (2004) Amputation as a marker of the quality of foot care in diabetes. Diabetologia 47:2051–2058

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To the Editor:

In their review [1], Jeffcoate and van Houtum quote two community-based studies from Germany [2, 3] that failed to demonstrate any decrease in amputation rates between 1990 and 1998. It should be mentioned, however, that no attempt was made to decrease the amputation rates in these communities during this period. In 2001, amputation rates estimated from hospital discharge data from all over Germany [4] remained unchanged as compared with those reported by earlier surveys [2, 3]. The German health authorities subsequently implemented diabetes disease management programmes for general practitioners, with emphasis on foot screening, and podiatry was made available on medical prescription for high-risk diabetic patients. However, it remains to be seen whether these interventions will decrease the incidence of amputation in the near future in the same way they did in The Netherlands [5].


  1. 1.

    Jeffcoate WJ, van Houtum WH (2004) Amputation as a marker of the quality of foot care in diabetes. Diabetologia 47:2051–2058

  2. 2.

    Trautner C, Giani G, Haastert B et al (2001) Unchanged incidence of lower limb amputations in a German city, 1990–1998. Diabetes Care 24:855–859

  3. 3.

    Stiegler H, Standl E, Frank S, Mendler G (1998) Failure of reducing lower extremity amputations in diabetic patients: results of two subsequent population based surveys in 1990 and 1995 in Germany. Vasa 27:10–14

  4. 4.

    Heller G, Günster C, Schellschmidt H (2004) What is the frequency of diabetes-related leg amputations in Germany [article in German]? Dtsch med Wochenschr 129:429–433

  5. 5.

    van Houtum WH, Rauwerda JA, Ruwaard D, Schaper NC, Bakker K (2004) Reduction in diabetes related lower extremity amputations in The Netherlands:1991–2000. Diabetes Care 27:1042–1046

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Correspondence to E. Chantelau.

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Chantelau, E. Comment. Diabetologia 48, 1032 (2005). https://doi.org/10.1007/s00125-005-1740-4

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  • Diabetic Patient
  • General Practitioner
  • Management Programme
  • Hospital Discharge
  • Disease Management