Foot and leg amputations were once a fairly common fate for diabetics, but new government research shows a dramatic decline in limbs lost to the disease, probably due to better treatments.
The rate has fallen by more than half since the mid-1990s, according to what is being called the most comprehensive study of the trend.
For older diabetics, amputations dropped from more than 11 to about 4 per 1,000 people, the Centers for Disease Control and Prevention reported Tuesday.
Other diabetes studies have shown declines in lost toes, feet and legs, but not as dramatic.
"What jumped out to me was the scale of the improvement," said Dr. John Buse, a University of North Carolina diabetes expert who was not involved in the new study.
The study was released Tuesday by the medical journal Diabetes Care.
Diabetes is a disease in which sugar builds up in the blood. Roughly 1 in 10 U.S. adults has it, and it is the seventh leading cause of death, the CDC says.
Complications include poor circulation and nerve damage in the lower limbs, resulting in numbness and slow healing of sores and infections. That's most common in elderly patients and those with diabetes for at least 10 years.
While diabetes has been growing more common in the United States - driven by obesity-related Type 2 - researchers have noted recent declines in some of the other most dreaded complications, including blindness and kidney failure.
Buse recalled seeing such problems constantly when he first became director of UNC's Diabetes Care Center in the mid-1990s.
"Pretty much every minute of every day in the waiting room, there would be somebody missing a limb, or with a seeing eye dog or white cane," he said.
But he hasn't seen a patient like that in his waiting room for a few years, he added.
In the CDC study, the researchers checked national hospital discharge records for 1988 through 2008, looking for patients aged 40 and older who had lost a toe, foot or leg to diabetes.
They found that though the number of people with the disease more than tripled over those two decades, foot and leg amputations fell after 1996.
The researchers also looked at people who did not have diabetes, and found the rates of amputation were flat.
It's not clear what happened to start the drop among diabetics, said Nilka Rios Burrows, a CDC epidemiologist who co-authored the study.
But experts note that was a decade in which studies clearly demonstrated the value of close monitoring and stepped-up patient education. It's also when Medicare began paying for blood sugar monitoring and for protective shoes and other medical devices for elderly diabetics.
CDC officials saw increases in the proportion of diabetics who got annual foot exams, and believe the enhanced care is the main reason for the decline in amputations.
But another element may be that larger numbers of diabetics are being diagnosed earlier and with milder disease, Burrows said.