Major lower-extremity amputations in diabetes: a response to “A Canadian population-based description of the indications for lowerextremity amputations and outcomes”

After reading the report by Kayssi and colleagues¹ that describes the nontraumatic lower-limb amputations in Canada during the 2006–2009 period, I would like to stress the importance of population-based studies focused in disease outcomes.

Despite the lack of clinically detailed information being the main limitation in the use of administrative databases, the research in this field is quite necessary because it brings a large panorama of quality of health care delivery, allowing regional and international comparisons as well.

Two findings of the aforementioned study are worth noting: diabetes was the leading cause of nontraumatic amputation in Canada (about 80% of the cases), and 1 of 3 cases corresponded to above-knee amputation (i.e., major lower-extremity amputations).

Major lower-extremity amputation is considered a devastating outcome in diabetes that reflects longstanding inadequate glycemic control and constitutes a strong indicator of the need to carry out medical interventions.

The characterization and even the control of amputations in patients with diabetes has been reached in some high-income countries, but the lack of epidemiological studies in most middleand low-income nations makes the management of the disease difficult.

In Mexico, major lower-extremity amputation in patients with diabetes is considered a growing public health problem that poses important challenges in terms of prevention, epidemiological characterization, medical treatment, and physical, social and emotional rehabilitation.