Non-traumatic lower extremity amputations (NLEA) are an important complication of diabetes. After a period of decline, some national U.S. data show that rates of diabetes-related NLEA have recently increased. Whether this varies by state is unknown. We used 100% Medicare claims for beneficiaries enrolled in Parts A and B during 2000-2017 to examine state-specific NLEA trends among adults ≥67 years with diabetes. NLEA was defined as the highest-level amputation per patient per calendar year. All rates were age-sex standardized to the 2000 study population. Trends were assessed using Joinpoint regression. National diabetes-related NLEA rates (per 1,000 persons) decreased from 8.5 in 2000 to 4.4 in 2009 (APC - 7.9, p<0.001), and then increased to 4.8 in 2017 (APC 1.2, p<0.001). However, standardized state-specific rates varied considerably over the entire time period from a maximum of 12.5 in Louisiana to a minimum of 2.6 in Hawaii. Many states showed an initial decline followed by an increase after 2009. Other states did not experience a similar increase. Our findings suggest that the recent national increase in NLEAs may be driven by only some states, while others have been able to maintain low rates. Determining reasons for the increase in some states and not others could help identify interventions to reverse the trend.


L.J. Andes: None. J. Harding: None. D.B. Rolka: None. G. Imperatore: None. Y. Li: None. E.W. Gregg: None. A.L. Albright: None.

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