Reduction of amputation rates among Alaska Natives with diabetes following the development of a high-risk foot program

Schraer, Cynthia D; Weaver, Daniel; Naylor, Julien Louise; Provost, Ellen; Mayer, Ann Marie

doi:10.3402/ijch.v63i0.17869

Cited by 16 publications

(20 citation statements)

References 11 publications

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“…While the diastolic pressures have decreased by 3 mm Hg from pre-SDPI to SDPI periods in our report, they were lower than 80 mm Hg to begin with. Amputation rates and dialysis/transplant rates among Alaska Native people with diabetes have been lower than in other Native American diabetic populations (17)(18)(19). It is possible that the lower levels of blood pressure among Alaska Native people with diabetes have resulted in the comparatively lower rates of amputation/ dialysis.…”

Section: Discussionmentioning

confidence: 93%

Effect of special diabetes program for Indians funding on system changes in diabetes care and outcomes among American Indian/Alaska Native people 1994–2004

Ramesh

Schraer

Mayer

et al. 2008

International Journal of Circumpolar Health

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Objectives. The Alaska Native Medical Center diabetes program analysed Diabetes Care and Outcomes Audit data from 1994-2004 to evaluate the impact of the Special Diabetes Program for Indians (SDPI) funding on process and intermediate outcomes. Study Design. We conducted a retrospective analysis of data from standardized medical records reviews conducted between 1994 and 2004 from regional sites in Alaska. Methods. We analysed 7,735 randomly selected records for trends over three time periods (pre-SDPI, transition and SDPI). Results. Hemoglobin A1c, total and LDL cholesterol, triglycerides and blood pressure significantly improved from the pre-SDPI to the SDPI period. However, as the number of people with diabetes increased, the percentage of patients receiving foot, eye and dental exams decreased, as did the percentage receiving nutrition, exercise and diabetes education. Conclusions. SDPI funding provided resources for interventions necessary to improve the effectiveness of diabetes care. This was associated with improved intermediate outcomes in American Indian/Alaska Native patients with diabetes. Further observations are needed to evaluate whether or not intermediate outcomes result in decreased cardiovascular disease, amputations, dialysis and retinopathy. (Int J Circumpolar Health 2008; 67(2-3):203-212)

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Section: Discussionmentioning

confidence: 93%

Effect of special diabetes program for Indians funding on system changes in diabetes care and outcomes among American Indian/Alaska Native people 1994–2004

Ramesh

Schraer

Mayer

et al. 2008

International Journal of Circumpolar Health

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“…Historically, this also seems to be true for the all U.S. diabetic population (29). Many reports show an association between the development of a multidisciplinary foot care program and a reduction in amputation rates and/or risk factors (3,7,23,30). While our previous reports (3,7) showed reductions in amputation rates associated with enhanced foot care services, the SDPI program markedly increased access to podiatrist services and comprehensive foot exams and care, including surgical interventions.…”

Section: Amputationsmentioning

confidence: 92%

“…Many reports show an association between the development of a multidisciplinary foot care program and a reduction in amputation rates and/or risk factors (3,7,23,30). While our previous reports (3,7) showed reductions in amputation rates associated with enhanced foot care services, the SDPI program markedly increased access to podiatrist services and comprehensive foot exams and care, including surgical interventions. Several studies in diabetic populations show an association between LEA and smoking, systolic blood pressure, hemoglobin A1c, duration of diabetes and low values of high-density lipoproteins (HDL) (26)(27)(28)(31)(32)(33).…”

Section: Amputationsmentioning

confidence: 92%

“…Progressive improvements in hemoglobin A1c, blood pressure and lipids were associated with public health initiatives in diabetes care and prevention (6). Amputation and renal replacement rates have been found to be lower than those in other populations, but rates vary widely among the major ethnic groups within Alaska (3,4,7).The purpose of this report is to examine trends in prevalence, incidence and mortality of diabetes, and incidence of amputations, renal replacement and mortality among Alaska Native people with diabetes.…”

Section: Introductionmentioning

confidence: 99%

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Diabetes prevalence, incidence, complications and mortality among Alaska Native people 1985–2006

Narayanan

Schraer

Bulkow³

et al. 2010

International Journal of Circumpolar Health

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Objectives. To examine trends in diabetes prevalence, incidence, complications and mortality between 1985 and 2006 among Alaska Native people. Study design. We used data from the population-based Alaska Native Diabetes Registry, which includes all people who receive care in the Alaska Tribal Health System. Methods. We compared the periods of 1986-1990 and 2002-2006 for diabetes-related amputations, renal replacement and mortality using Poisson regression. Complications and mortality data were examined for trends using Poisson regression. Survival analyses for those diagnosed since 31 December 1985 were performed using the Cox proportional hazard model. Results. Age-adjusted diabetes prevalence increased from 17.3 in 1985 to 47.6/1,000 in 2006. The number of Alaska Native people living in Alaska with diabetes increased from 610 in 1985 to 3,386 in 2006. Diabetes incidence rates have also increased. Comparing age-adjusted rates for the 5-year periods 1986-1990 and 2002-2006, amputations decreased from 5.3 to 2.6/1,000, renal replacement decreased from 3.3 to 1.2/1,000 and mortality decreased from 41.7 to 33.2/1,000. Yearly analyses showed a downward trend for amputations, renal replacement and mortality rates. Survival analyses showed a significantly higher hazard ratio for any amputations, major amputations and renal replacement for the earlier time period compared to the most recent time period.Conclusions. An increase in risk factors, awareness, funding and case-finding may be contributing to the increase in prevalence and incidence of diagnosed diabetes. While diabetes prevalence and incidence are increasing among Alaska Native people, our results suggest that even in remote, rural areas, complications and mortality can be reduced.

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“…In recent years, decreasing incidence rates of amputations were reported from several areas in the U.S., Finland, the Netherlands, and Italy (3,(5)(6)(7)(8)(9)(10). By contrast, no data showing a reduction of amputations since 1989 in any part of Germany have been published to date (3,11,12).…”

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confidence: 94%

Reduced Incidence of Lower-Limb Amputations in the Diabetic Population of a German City, 1990–2005

et al. 2007

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OBJECTIVE -We evaluated whether the incidence of amputations in one German city (Leverkusen, population ϳ160,000) had decreased between 1990 and 2005. RESEARCH DESIGN AND METHODS-From all three hospitals in the city, we obtained complete lists of nontraumatic lower-limb amputations in 1990 -1991 and 1994 -2005. Only the first observed amputation in residents of Leverkusen was counted. A total of 692 patients met the inclusion criteria. Data about the population stucture, separately for each year of the observation period, were received from the city administration and the Federal Office of Statistics. To test for time trend, we fitted Poisson regression models.RESULTS -Of all subjects, 72% had known diabetes and 58% were male. Mean age was 71.7 years. Incidence rates in the diabetic population (standardized to the estimated German diabetic population per 100,000 person-years) varied considerably between years (maximum 549 in 1990, minimum 281 in 2004). In the diabetic population, the estimated relative risk (RR) per year was 0.976 (95% CI 0.958 -0.996, P ϭ 0.0164). The same trend was observed when only amputations above the ankle (n ϭ 352) , P ϭ 0.0318) were considered. Over 15 years, an estimated reduction of amputations above the toe level by 37.1% (95% CI 12.3-54.8) results. There was no significant change of incident amputations in the nondiabetic population (RR 1.022 [0.989 -1.056], P ϭ 0.1981).CONCLUSIONS -This finding is likely to be due to improved management of the diabetic foot syndrome after a network of specialized physicians and defined clinical pathways for wound treatment and metabolic control were introduced. Diabetes Care 30:2633-2637, 2007I n 1989, a reduction of the number of amputations in the diabetic population by at least one-half within 5 years was declared a primary objective for Europe (St. Vincent Declaration) (1). We published baseline data about the incidence rates of amputations in the city of Leverkusen, Germany, in 1990 and 1991, as well as follow-up data through 1998 (2,3). We found that the risk of having an amputation was 26-fold (95% CI 17-39) in the diabetic population compared with that in the nondiabetic population. Moreover, 96% (94 -97) of the amputation risk in diabetic individuals and 70% (61-77) of the amputation risk in the entire population were due to diabetes (2,3). We estimated that ϳ31,000 patients in Germany underwent first amputations per year, that 23,000 of these patients had diabetes, and that 21,000 had their amputations due to their diabetes (4). No change in incidence rates over time could be detected between 1990 and 1998 (3). In the present study, we continued the collection of these data from 1999 through 2005 and combined them with the existing dataset to ascertain a potential change in incidence rates.The incidence of amputations in diabetic individuals dropped significantly in several areas in various countries and populations, such as Alaska Natives, American Indians, Denmark, and Sweden, after various specific programs for foot care and prevention...

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Reduction of amputation rates among Alaska Natives with diabetes following the development of a high-risk foot program

Cited by 16 publications

References 11 publications

Effect of special diabetes program for Indians funding on system changes in diabetes care and outcomes among American Indian/Alaska Native people 1994–2004

Effect of special diabetes program for Indians funding on system changes in diabetes care and outcomes among American Indian/Alaska Native people 1994–2004

Diabetes prevalence, incidence, complications and mortality among Alaska Native people 1985–2006

Reduced Incidence of Lower-Limb Amputations in the Diabetic Population of a German City, 1990–2005

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