This study followed 217,207 New Zealanders with diabetes from 2010 until the end of 2013 for lower limb amputations, and to the end of 2014 for mortality. 784 individuals (3.6 cases/1,000 individuals) underwent a major (aboveankle) lower limb amputation during follow-up; 1,217 (5.6/1,000) underwent a minor (below-ankle) amputation. The risk of major and minor amputation was 39% and 77% greater for men than women, respectively (adjusted HR: major amputation 1.39; 95% CI, 1.20 to 1.61; minor amputation 1.77; 95% CI, 1.56 to 2.00). Indigenous Māori were at far higher risk of aboveknee amputation compared with European/Other diabetics (HR 1.65; 95% CI, 1.37 to 1.97). Amputation risk increased with increasing comorbidity burden; of all comorbid conditions, peripheral vascular disease conferred the greatest independent risk. Prior minor amputation increased the risk of subsequent major amputation by 10-fold (HR 10.04; 95% CI, 7.83 to 12.87) and increased the risk of another minor amputation by 20-fold (HR 21.39; 95% CI, 17.89 to 25.57). Death was common among the total cohort, but particularly among those who underwent amputation, with more than half of those who underwent a major amputation dying within 3 years of their procedure (57%).
