Manitoba's diabetes-associated leg amputations higher than national average, new report says

Manitoba saw more than double the national average of diabetes-associated leg amputations between 2020 and 2023, according to a Canadian Institute for Health Information report published Thursday.

The new report includes data from across the country to "examine equity in diabetes care, with a focus on lower limb amputations," and provides insight into which populations are most affected. 

"Amputations … it's a really devastating outcome," said Geoff Hynes, manager of population health at the Canadian Institute for Health Information.

"It's life-altering for patients, families and so I think, you know, that that's a really important reason why we thought this was an important topic." 

The numbers show age-standardized rates of diabetes-associated leg amputations were 19 per 100,000 in Manitoba, compared with nine per 100,000 nationally. 

That's approximately 200 leg amputations annually, said Hynes. 

"That is a very large number," he said.

Hynes said it can be challenging to draw comparisons across different provinces and territories. However, he said CIHI's analysis has found that people living in remote areas tend to have higher rates of leg amputations, and that could be one of the factors contributing to Manitoba's numbers. 

"This is a challenging issue," said Hynes. "I've heard 'this isn't rocket science,' this is actually harder and I think this is an issue that's going to require action among many different levels — prevention, primary care, acute care in order to get this number down." 

Manitoba also saw more ankle-and-below amputations compared to the national average with 19 per 100,000 compared with 14, according to the report titled Equity in diabetes care: A focus on lower limb amputation. 

During the period of time looked at by CIHI, the report found in Canada, among those 18 and older, there were around 7,720 lower limb amputations associated with diabetes annually. Of those, 3,080 hospitalizations involved a leg amputation and 4,640 were for an ankle, foot or toe, according to the report.  

The report states roughly 43 per cent of amputations occurred among people with diabetes age 40 to 64 and that males with diabetes were two to three times more likely to have an amputation or be hospitalized as a result of a lower limb complication. 

Populations most impacted

The report also says lower limb complications were more common for people who live in neighbourhoods "with lower income, lower high school completion and higher social deprivation, as well as in rural and remote communities." 

"We're particularly interested in understanding which populations are most impacted," said Hynes. "I think what we see is that social, economic, geographic and other issues really play a major oversized role in this issue." 

He said amputations are in many cases avoidable. 

"With access to early screening and appropriate clinical care you can avoid having these amputations," said Hynes. 

The report states that "up to 85 per cent of leg amputations are preventable."

Hynes said he hopes the information presented will help better direct where resources are needed. 

"For example, when we see in our report that people who live in lower income areas have much higher rates of these amputations, well, I want to think about, OK, well what what might be the barriers that those individuals are facing to get the early screening and to get that access to care.

"And so what we know is that lower income people more often than not have difficulty connecting with regular primary care providers. So if you don't have that access to a regular provider, you may be at risk for having, you know, unmet care needs, which can lead to these, you know, awful complications related to diabetes."

Hynes said foot screening is important and if an issue is detected, people require urgent access to specialty care. 

"You need to get in to see that specialist so you can get the wound care, antibiotics, other treatments that can help you recover from a diabetic ulcer," he said.