Since amputation of a lower extremity predisposes patients with diabetes to a lower quality of life and higher rates of cardiovascular events and mortality, identifying predictors of amputation is of clinical relevance in diabetes management. Although the incidence of amputation is known to be much lower in East Asians compared to those in Western countries, there has been no large cohort study of the accurate incidence of amputations in East Asians. Thus we analyzed data from a nationwide claims database involving 17,288 individuals with diabetes in Japan (2942 women, mean age 50.2 y, HbA1c 7.2%) from 2008-16. During a mean follow-up period of 5.3 y, 16 amputations occurred (0.17/1000 person-years), which was about one tenth of the typical rates reported by Western countries. Multivariate Cox regression analysis showed that age and HbA1c were independent predictors of amputation (hazard ratio (HR) 1.11(95% CI 1.03-1.19) and 1.43(1.13-1.81), respectively). Compared with those age <58 y and with HbA1c <8%, the HR for those age ≥58 y and HbA1c ≥8% was 32.0 (7.72-133.5). Kaplan-Meyer analysis confirmed the strikingly high risk in this category (Figure). Our results implied large differences in incidence and risk profiles for amputation in Japanese patients with diabetes, suggesting the need for ethnic group-specific strategies to prevent diabetic foot disease. Disclosure M. Kaneko: None. K. Fujihara: None. M. Yamamoto: None. M. Kitazawa: None. M. Ishizawa: None. T. Osawa: None. M. Harada: None. Y. Matsubayashi: None. T. Yamada: None. H. Sone: Research Support; Self; Novo Nordisk Inc., Eli Lilly and Company, MSD K.K., Chugai Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Daiichi Sankyo Company, Limited, Ono Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Sanofi, Kowa Pharmaceuticals America, Inc., Eisai Inc..