Diabetic Foot Complications in a Northern Canadian Aboriginal Community

Reid, Kristin S.; Martin, Bruce D.; Duerksen, Frank; Nicolle, Lindsay E.; Garrett, Mark; Simonsen, J. Neil; Trepman, Elly; Embil, John M.

doi:10.1177/107110070602701212

Cited by 34 publications

(43 citation statements)

References 49 publications

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“…Standardized foot assessment in one remote community found clinical evidence of PAD was common: one or both pedal pulses were absent in 41% of 169 participants, 8% had rest pain or intermittent claudication and 5% had undergone lower extremity bypass [21]. Retrospective auditing of a representative sample of 19/20 First Nation communities' medical charts (21% non-isolated, 34% semiisolated and 45% remote) reported a prevalence of PAD of 2.4% (range: 0.0-13.7%) [23].…”

Section: Management Perspective Schoen and Normanmentioning

confidence: 98%

“…Methodological factors such as the number and type of tests used to diagnose DSPN and the nature of the cohort influence the reported prevalence, making assessment and comparison of true prevalence difficult. Cohort studies which include dedicated clinical testing for DSPN, suggest the prevalence is in the range of 30-50% [19][20][21][22]. However, when identified by chart audit, the prevalence of reported DSPN is much lower (generally <30%) than for dedicated clinical testing [14,[23][24][25].…”

Section: Risk Factors For Diabetic Foot Disease In Indigenous Peoplementioning

confidence: 99%

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Diabetic foot disease in Indigenous people

Schoen

Norman²

2014

Diabetes Management

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This article will examine what is known about the epidemiology of diabetic foot disease in Indigenous people and what strategies have been used to manage the problem. The prevalence of diabetes is several-fold higher in Indigenous people compared with non-Indigenous people. The prevalence of diabetic peripheral neuropathy varies but in general it appears to be more common and start at a younger age in Indigenous compared with non-Indigenous people. Peripheral artery disease is also more prevalent and the incidence of lower extremity amputation is higher. Various strategies have been shown to be effective in the delivery healthcare for diabetic foot disease in Indigenous people. There are, however, social and political barriers to the implementation and success of these interventions.

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Section: Management Perspective Schoen and Normanmentioning

confidence: 98%

Section: Risk Factors For Diabetic Foot Disease In Indigenous Peoplementioning

confidence: 99%

Diabetic foot disease in Indigenous people

Schoen

Norman²

2014

Diabetes Management

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“…3,[26][27][28]31,32,[36][37][38][39][40][41][42][43][44][48][49][50][51]53,54,[56][57][58][59][60][61][62][63]73,74 The choice of denominator for the remainder of the studies included the total current caseload 29,30,64,69,[75][76][77][78]82 of health-care professionals or the provider organisation, the sample surveyed (not clear if these were representative samples of geographical populations) [45][46][47]55,62,[65][66][67][68]70 and respondents to the survey. …”

Section: Denominator Datamentioning

confidence: 99%

Wounds research for patient benefit: a 5-year programme of research

Cullum

Buckley

Dumville

et al. 2016

Programme Grants Appl Res

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BackgroundComplex wounds are those that heal by secondary intention and include lower-limb ulcers, pressure ulcers and some surgical wounds. The care of people with complex wounds is costly, with care mainly being delivered by community nurses. There is a lack of current, high-quality data regarding the numbers and types of people affected, care received and outcomes achieved.ObjectivesTo (1) assess how high-quality data about complex wounds can be captured effectively for use in both service planning and research while ensuring integration with current clinical data collection systems and minimal impact on staff time; (2) investigate whether or not a clinical register of people with complex wounds could give valid estimates of treatment effects, thus reducing dependence on large-scale randomised controlled trials (RCTs); (3) identify the most important research questions and outcomes for people with complex wounds from the perspectives of patients, carers and health-care professionals; (4) evaluate the potential contributions to decision-making of individual patient data meta-analysis and mixed treatment comparison meta-analysis; and (5) complete and update systematic reviews in topic areas of high priority.MethodsTo meet objectives 1 and 2 we conducted a prevalence survey and developed and piloted a longitudinal disease register. A consultative, deliberative method and in-depth interviews were undertaken to address objective 3. To address objectives 4 and 5 we conducted systematic reviews including mixed treatment comparison meta-analysis.ResultsFrom the prevalence survey we estimated the point prevalence of all complex wounds to be 1.47 per 1000 people (95% confidence interval 1.38 to 1.56 per 1000 people). Pressure ulcers and venous leg ulcers were the most common type of complex wound. A total of 195 people with a complex wound were recruited to a complex wounds register pilot. We established the feasibility of correctly identifying, extracting and transferring routine NHS data into the register; however, participant recruitment, data collection and tracking individual wounds in people with multiple wounds were challenging. Most patients and health professionals regarded healing of the wound as the primary treatment goal. Patients were greatly troubled by the social consequences of having a complex wound. Complex wounds are frequently a consequence of, and are themselves, a long-term condition but treatment is usually focused on healing the wound. Consultative, deliberative research agenda setting on pressure ulcer prevention and treatment with patients, carers and clinicians yielded 960 treatment uncertainties and a top 12 list of research priorities. Of 167 RCTs of complex wound treatments in a systematic review of study quality, 41% did not specify a primary outcome and the overall quality of the conduct and reporting of the research was poor. Mixed-treatment comparison meta-analysis in areas of high priority identified that matrix hydrocolloid dressings had the highest probability (70%) of being the most effective dressing for diabetic foot ulcers, whereas a hyaluronan fleece dressing had the highest probability (35%) of being the most effective dressing for venous ulcers; however, the quality of this evidence was low and uncertainty is high.ConclusionsComplex wounds are common and costly with a poor evidence base for many frequent clinical decisions. There is little routine clinical data collection in community nursing. A prospective complex wounds register has the potential to both assist clinical decision-making and provide important research evidence but would be challenging to implement without investment in information technology in NHS community services. Future work should focus on developing insights into typical wound healing trajectories, identifying factors that are prognostic for healing and assessing the cost-effectiveness of selected wound treatments.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…Most studies merely observe the rates of DFD amongst an Aboriginal population with no comparison to non-indigenous population [50,62,81]. However, there is evidence that Aboriginal people have a higher burden of DFD-related issues compared to non-Aboriginal peoples [38,55] in Canada.…”

Section: Indigenous Status and Diabetic Foot Disease Developed Countriesmentioning

confidence: 99%

“…As this study demonstrated that Indigenous individuals with lower SES were at higher risk of DRLEA [61], it is likely that the data source and area-level measure accurately measured SES and DRLEA prevalence. In regards to GR, Indigenous status and association to DRLEA and/or DFD, no information exists in regards to comparable non-Indigenous populations [56,81] . Information exists for DRLEA and DFD rates for regional to remote Indigenous communities; however, the GR was never a measureable variable.…”

Section: Australiamentioning

confidence: 99%

Socio-Economic, Geographic, and Aboriginal and Torres Strait Islander Inequalities in Diabetic Foot Disease and Diabetes-Related Lower Extremity Amputations

Singh¹

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Diabetic Foot Complications in a Northern Canadian Aboriginal Community

Cited by 34 publications

References 49 publications

Diabetic foot disease in Indigenous people

Diabetic foot disease in Indigenous people

Wounds research for patient benefit: a 5-year programme of research

Socio-Economic, Geographic, and Aboriginal and Torres Strait Islander Inequalities in Diabetic Foot Disease and Diabetes-Related Lower Extremity Amputations

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