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The authors regard the incidence of foot amputations (OPS code 5–865) as an efficiency criterion for T2DM (1). However, OPS code 5–865 entails amputations of parts of the foot, e.g. of single toes (minor amputations), which do not always lead to serious impairment or necessitate a prosthesis. By contrast, the crucial criterion is saving the leg and, thus, OPS code 5–864 (leg amputations). Whenever leg-saving measures are applied successfully in cases of gangrene of a foot, only minor amputations instead of leg amputations are required. If accompanied by a low incidence of major amputations (OPS code 5–864), a high incidence of minor amputations (OPS code 5–865) could therefore point to a high efficiency of the management program. Since the start of the DMP for type 2 diabetes, the incidence of leg amputations in all members of the general statuary sickness fund (AOK) of Westphalia-Lippe has decreased successively from 46/100 000 in 2000 to 26/100 000 in 2008 (while the incidence of amputations below the ankle has increased; personal communication). What is the incidence of leg amputations in the groups of T2DM patients studied by Linder et al. (1)?

DOI: 10.3238/arztebl.2011.0721b

Prof. em. Dr. med. Ernst Chantelau

Bremen

chantelau@gmx.de

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Linder R, Ahrens S, Köppel D, Heilmann T, Verheyen F: The benefit and efficiency of the disease management program for type 2 diabetes. Dtsch Arztebl Int 2011; 108(10): 155–62. VOLLTEXT
1.Linder R, Ahrens S, Köppel D, Heilmann T, Verheyen F: The benefit and efficiency of the disease management program for type 2 diabetes. Dtsch Arztebl Int 2011; 108(10): 155–62. VOLLTEXT