Affiliation:
1. Department of Surgery, Diabetex Research Group, Baltimore, Maryland
2. The Department of Orthopedic Surgery and Rehabilitation, Loyola University, Chicago, Illinois
3. Department of Orthopaedics, Southern Arizona Veterans Affairs Medical Center, Tucson, Arizona
4. Department of Medicine, Manchester Royal Infirmary, Manchester, United Kingdom
5. Department of Medicine, University of Miami School of Medicine, Miami, Florida
Abstract
OBJECTIVE—To report the incidence of diabetes-related lower-extremity complications in a cohort of patients enrolled in a diabetes disease management program.
RESEARCH DESIGN AND METHODS—We evaluated screening results and clinical outcomes for the first 1,666 patients enrolled in a disease management program for a period of 24 months (50.3% men, aged 69.1 ± 11.1 years).
RESULTS—The incidence of ulceration, infection, amputation, and lower-extremity bypass was 68.4, 36.5, 5.9, and 7.7 per 1,000 persons with diabetes per year. Amputation incidence was higher in Mexican Americans than in non-Hispanic whites (7.4/1,000 vs. 4.1/1,000; P = 0.003, odds ratio [OR] 1.8, 95% CI 1.2–2.7). The amputation-to-ulcer ratio was 8.7%. The incidence of Charcot arthropathy was 8.5/1,000 per year. Charcot was more common in non-Hispanic whites than in Mexican Americans (11.7/1,000 vs. 6.4/1,000; P = 0.0001, 1.8, 1.3–2.5). The prevalence of peripheral vascular disease was 13.5%, with no significant difference based on ethnicity (P = 0.3). There was not a significant difference in incidence of foot infection (P = 0.9), lower-extremity bypass (P = 0.3), or ulceration (P = 0.1) based on ethnicity. However, there were more failed bypasses in Mexican Americans (33%) than in non-Hispanic whites (7.1%). Mexican Americans were 3.8 times more likely to have a failed bypass (leading to an amputation) or be diagnosed as “nonbypassable” than non-Hispanic whites (75.0 vs. 44.0%; P = 0.01, 3.8, 1.2–11.8).
CONCLUSIONS—The incidence of amputation is higher in Mexican Americans, despite rates of ulceration, infection, vascular disease, and lower-extremity bypass similar to those of non-Hispanic whites. There may be factors associated with failed or failure to bypass that mandate further investigation.
Publisher
American Diabetes Association
Subject
Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine
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