Effectiveness of a comprehensive diabetes lower-extremity amputation prevention program in a predominantly low-income African-American population.

Patout, Charles A.; Birke, James A.; Horswell, Ron; Williams, David M.; Cerise, Frederick P.

doi:10.2337/diacare.23.9.1339

Cited by 103 publications

(67 citation statements)

References 11 publications

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“…This reduces the rate of contralateral limb loss in patients with diabetes mellitus as the rate of contralateral limb loss ranges from 6-15% per year and up to 56% over five years after major lower extremity amputation (Fig 2). There is a greater need to devote more time in the examination of the contralateral limb as well as patient education in prophylactic skin and foot care [18]. These education programmes reduce the number of major amputations in patients with diabetes mellitus up to 50% as patients developing foot lesions have significantly less knowledge of diabetes including foot care.…”

Section: Discussionmentioning

confidence: 99%

Amputation in Diabetic Patients

Singh¹,

Chawla²

2006

Medical Journal Armed Forces India

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Background: Foot ulcers and their complications are an important cause of morbidity and mortality in diabetes. The present study examines the amputation risk criterion and the long term outcome in terms of amputations and mortality in patients with diabetic foot. Methods: 27 patients with diabetic foot lesions were studied. There were 15 patients with early lesions and 10 with advanced lesions. 15 patients were managed conservatively including local amputations and 12 with lower extremity amputations. 80% patients were males in 45-59 years of age group and all patients had more than 6 years of poorly controlled diabetes. Results: Precipitating factors included walking barefoot, history of minor trauma, infection, callosities or burns in 86% of patients. Major lower limb amputations were common in irregularly treated, poorly controlled diabetics due to infection in a limb devitalized by angiopathy and desensitised by neuropathy. Conclusion: Diabetic foot ulcers are associated with high morbidity and mortality. Mortality was higher in ischaemic ulcers than neuropathic ulcers. MJAFI 2006; 62 : 36-39

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Section: Discussionmentioning

confidence: 99%

Amputation in Diabetic Patients

Singh¹,

Chawla²

2006

Medical Journal Armed Forces India

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“…Following the introduction of targeted education and care programmes in high-risk populations in the US, a decrease in the total incidence of amputation in diabetes has been reported by some groups [26,49,62], but not all [63]. In the Veterans Health Administration population, the decrease Note the factors listed in the main text that hamper comparison between centres.…”

Section: Amputation In Diabetesmentioning

confidence: 99%

“…For example, 4.6% of all diabetic Mexican Americans aged >65 years have lost a leg [25]. This may be truly racial and reflect metabolic differences between different groups [26]; however, this is difficult to confirm due to the influence of diet, lifestyle, cultural beliefs and socio-economic factors [27, 28, 29, [30], 31]. If a racial group constitutes an ethnic minority in a multicultural society, then differences between groups may reflect varying access to healthcare services.…”

Section: Factors Influencing the Incidence Of Amputationmentioning

confidence: 99%

Amputation as a marker of the quality of foot care in diabetes

2004

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Strategic targets for the management of foot ulcers focus on reducing the incidence of amputation. While data on the incidence of amputation can be obtained relatively easily, the figures require very careful interpretation. Variation in the definition of amputation, population selection and the choice of numerator and denominator make comparisons difficult. Major and minor amputation have to be distinguished as they are undertaken for different reasons and are associated with different costs and functional implications. Many factors influence the decision of whether or not to remove a limb. In addition to disease severity, co-morbidities, and social and individual patient factors, many aspects of the structure of care services affect this decision, including access to primary care, quality of primary care, delays in referral, availability and quality of specialist resources, and prevailing medical opinion. It follows that a high incidence of amputation can reflect a higher disease prevalence, late referral, limited resources, or a particularly interventionist approach by a specialist team. Conversely, a low incidence of amputation can indicate a lower disease prevalence or severity, good management of diabetes in primary and secondary care, or a particularly conservative approach by an expert team. An inappropriately conservative approach could conceivably enhance suffering by condemning a person to months of incapacity before they die with an unhealed ulcer. The reported annual incidence of major amputation in industrialised countries ranges from 0.06 to 3.83 per 10 3 people at risk. Some centres have documented that the incidence is falling, but this is often from a baseline value that was unusually high. Other centres have reported that the incidence has not changed. The ultimate target is to achieve not only a decrease in incidence, but also a low overall incidence. This must be accompanied by improvements in morbidity, mortality, and patient function and mood.

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“…Based on the results of the approximately 6000, blacks and Hispanics were less likely to use a majority of preventive services when compared with non-Hispanic whites [45]. Although the use of these services was low, diabetes prevention programs are very effective in low-income, minority populations, reducing lengths of hospital stays, rates of amputation, emergency room visits, and antibiotic prescriptions [46,48]. For preventive care to be effective in reducing the number of amputations, the patient must be compliant with medications, exercise, and routine interactions with their primary care practitioner.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Amputations in Minorities

Lefebvre

Lavery

2011

Clinical Orthopaedics &Amp; Related Research

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Background As a result of the impact of health disparities on the healthcare system such as their influence on arenas significant to healthcare distribution, including cost, quality, and access, identification and resolution of health disparities is a primary national agenda item. Resolution of disparities in amputation is an area of opportunity that warrants further consideration. Questions/purposes The purposes of our review are to highlight current data on disparities in amputation in minorities and to consider future goals related to an elimination of this disparity. Methods Studies on disparities in amputation were accessed using the following databases: PubMed, Cinahl, OVID/Medline, Embase, and Cochrane databases. In each database, a search of title/abstract was performed for the search terms ''disparities and amputation,'' ''race and amputation,'' and ''diabetes and amputation.'' Each search was limited by human and English language. Where are we now? A disparity exists in both frequency and level of amputation in minorities both in the presence and absence of a diagnosis of diabetes.Where do we need to go? A need exists for future research involving a more deliberate examination of the use of preventive screening for patients at high risk for amputation across medical settings. How do we get there? Research in this area would benefit from funding, large-scale data collection, and physician exposure to education on high-risk patients and preventive screening opportunities.

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Effectiveness of a comprehensive diabetes lower-extremity amputation prevention program in a predominantly low-income African-American population.

Cited by 103 publications

References 11 publications

Amputation in Diabetic Patients

Amputation in Diabetic Patients

Amputation as a marker of the quality of foot care in diabetes

Disparities in Amputations in Minorities

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