Table 1.

Recent (2015 to 2021) publications with population-based data regarding trends in diabetes complications

Country	Study	Years of data	Data	Denominator	Numerator	Findings
USA	Cai [51]	2008–2018	Veterans Affairs database	Veterans (6,493,141)	Incidence of LEA	Increased overall (12.9 to 18.1 per 10,000 individuals) but declined in women 62% of the increase was in toe amputations
USA	An [52]	2003–2014	Kaiser Permanente database	Incident T2DM cases (135,199)	Incidence of 13 complications and all-cause mortality	5-year incidence rates declined over time Neuropathy, CKD and CVD were the most common complications
Spain	López-de-Andrés [53]	2001–2018	National hospital discharge database	People with DM	UTI hospitalisation and in-hospital mortality	From 2001–2003 to 2016–2018 admissions per 100,00 individuals increased from 290.8 to 568.5 for DM and 74.8 to 144.0 for non-DM In-hospital mortality declined over time
Spain	Orozco-Beltrán [54]	2005–2015	National hospital discharge database	People with DM	Hospitalisation due to hypoglycaemia and mortality	Admissions per 100,000 individuals decreased from 21.5 to 13.2 in women and from 30.2 to 23.7 in men Mortality (per 100,000 individuals) declined from 8.6 to 4.1 in women and from 9.4 to 6.4 in men
Portugal	Ramalho [55]	2016–2017	National quality improvement registry	People with DM	Preventable hospitalisations	Decreased from 79 to 65.2 per 100,000 individuals
South Korea	Park [56]	2006–2015	National health insurance database	People with DM	Hospitalisation due to vascular complications and mortality	CVD events declined; hospitalisations due to CHF (per 10,000 individuals) increased from 124 to 161 in women and from 72 to 146 in men; hospitalisations for PAD (per 10,000 individuals) increased from 19 to 35 in women and from 39 to 55 in men Mortality from cancers, CVD, DM and HTN declined but mortality from pneumonia increased
South Korea	You [57]	2004–2013	National health insurance database	Population	Hospitalisation due to hyperglycaemia and in-hospital mortality	2004–2006: increased (1.8 to 2.6 per 1000 individuals) 2007–2013: decreased (2.5 to 2.2 per 1000 individuals) Mortality declined
South Korea	Kim [58]	2011–2016	National health insurance database	People with diabetic foot	LEA and revascularisation	Total LEAs increased with flat/declining major amputations; revascularisation interventions increased
Hong Kong	Wu [59]	2001–2016	Electronic medical record diabetes registry	People with DM (770,078)	Hospitalisation for LEA	Decreased (per 10,000 individuals) for minor LEAs (from 14.0 to 7.2 in men [−48.6%] and from 7.9 to 3.2 in women [−59.5%]) and major LEAs (from 19.5 to 4.3 in men [−77.9%] and from 11.6 to 2.4 in women [−79.3%]) Similar findings for newly diagnosed DM and T1DM
Taiwan	Lin [60]	2007–2014	National health insurance database	People with T2DM	Diabetic foot complications (ulcers, infections, gangrene, PAD hospitalisation)	Decreased LEAs (2.9 to 2.1 per 1000 individuals) Major LEAs declined from 56.2% to 47.4% of all LEAs
Brazil	Florêncio [61]	2008–2019	National hospital registry	Population	Hospitalisation related to DM	Increased hospitalisations, higher in female sex; variation in mortality by region

The literature included is composed of articles that reported data with international, national or at least subnational coverage and data sources such as registries or administrative/discharge records. This table does not include publications up to 2015 and is intended as an update to prior reviews [3]

CHF, congestive heart failure; CKD, chronic kidney disease; DM, diabetes mellitus; HTN, hypertension; LEA, lower-extremity amputation; PAD, peripheral arterial disease; T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus