Defining the gap: a systematic review of the difference in rates of diabetes‐related foot complications in Aboriginal and Torres Strait Islander Australians and non‐Indigenous Australians

Abstract

BackgroundThe Aboriginal and Torres Strait Islander community has an increased risk of developing chronic illnesses including diabetes. Among people with diabetes, foot complications are common and make a significant contribution to the morbidity and mortality associated with this disease. The aim of this review was to systematically evaluate the literature comparing the rates of diabetes related foot complications in Aboriginal and Torres Strait Islander Australians to non-Indigenous Australians.MethodsMEDLINE, EMBASE, The Cochrane Library; PUBMED and CINAHL were searched from inception until August 2016. Inclusion criteria were: published cross-sectional or longitudinal studies reporting the prevalence of diabetes related foot complications in both a cohort of Aboriginal and Torres Strait Islander Australians and a cohort of one other Australian population of any age with diabetes. Risk of bias was assessed using the STROBE tool.ResultsEleven studies including a total of 157,892 participants were included. Studies were set in Queensland, the Northern Territory and Western Australia, primarily in rural and remote areas. Aboriginal and Torres Strait Islander Australians experienced substantially more diabetes related foot complications with the mean age up to 14 years younger than non-Indigenous Australians. Aboriginality was associated with increased risk of peripheral neuropathy, foot ulceration and amputation. In several studies, Aboriginal and Torres Strait Islander Australians accounted for the vast majority of diabetes related foot complications (up to 91%) while comprising only a small proportion of the regional population. Reporting quality as assessed with the STROBE tool showed underreporting of: methods, sample description and potential sources of bias. There are no data available for some Australian states and for specific types of diabetes related foot complications.ConclusionsAboriginal and Torres Strait Islander Australians have a 3–6 fold increased likelihood of experiencing a diabetes related foot complication compared to non-Indigenous Australians. Evidence-based, culturally appropriate screening and intervention programs and improved access to effective health care services are required to prevent a widening of the gap in diabetes related foot complications between Aboriginal and Torres Strait Islander and non-Indigenous Australians.

Diabetes‐related foot disease in Australia: a systematic review of the prevalence and incidence of risk factors, disease and amputation in Australian populations

“…Interestingly, we found no marked differences between Indigenous and non-Indigenous people for these risk factors, in contrast to a previous systematic review [ 40 ]. This may be explained by our tighter inclusion criteria that included only population-based publications and in turn only identified studies from urban settings [ 32 ], while the previous review predominantly identified single site clinic-based studies from remote settings [ 40 ], with geographical remoteness known to increase DFD rates [ 41 ].…”

“…We also found differences in amputation rates within different sub-populations of Australia. Interestingly, we found up to 38 fold higher rates for amputations in Indigenous populations compared to the non-Indigenous population [ 23 ], and much higher than the 3–6 fold higher rates for amputations in Indigenous populations reported in the previously discussed systematic review [ 40 ]. Perhaps implicated in this finding, was that we also found geographical variation in amputation rates in two nation-wide publications [ 20 , 31 ].…”

Pathway to ending avoidable diabetes‐related amputations in Australia

“…Best estimates show that about 50 000 Australians have DFD (ulcers, infections and ischaemia) and 300 000 have major risk factors (peripheral neuropathy and peripheral arterial disease) for developing DFD 4 . Indigenous Australians are disproportionally affected, with a 3–6‐fold increased likelihood of developing DFD 8 …”

“…4 Indigenous Australians are disproportionally affected, with a 3e6fold increased likelihood of developing DFD. 8 DFD is a complex condition that is not easily identified, prevented or treated. 1,9 It commonly develops from trauma in the presence of peripheral neuropathy or peripheral arterial disease and is complicated by infection.…”

Editorial: Diabetic foot - A global health challenge

“…9 Additionally, Aboriginal and Torres Strait Islander peoples have a 3-6 times greater risk of diabetic foot ulcer than the non-Indigenous population. [9][10][11] Australian data provide indirect evidence that strategies to improve community-and hospital-based foot care for patients with type 2 diabetes are beneficial. 9 In this month's issue of Australian Journal of General Practice, Reardon and colleagues explore the multidisciplinary approach focusing on frequent assessment, early recognition and management of diabetic foot as the central focus in reducing the associated morbidity and mortality.…”