Prevention and Early Intervention for Diabetes Foot Problems
Research articles, most published since 1990, were identified and retrieved through computerized searches of the National Library of Medicine database (MEDLINE). This review is not meant to summarize the entire literature on the subject, but rather to present a condensation and consolidation of the major findings concerned with prevention of and early intervention for diabetes foot disease. Key points are highlighted in boldface.
2. The Scope of the Problem
National Goals for Diabetes Foot Care
The U.S. Department of Health and Human Services' report specifying health objectives for the nation, Healthy People 2000, calls for a 40 percent overall reduction in lower extremity amputations (LEA) due to diabetes by the year 2000. A special population target goal for amputations is to reduce the 1984-87 rate of amputations in African Americans from 10.2 to 6.1 per 1,000 by the year 20001. These goals are based on the estimate that at least 50 percent of the amputations that occur each year in people with diabetes can be prevented through proper foot care. To achieve the targeted 40 percent reduction, at least 80 percent of people with diabetes at high risk for lower extremity amputations must receive effective clinical management and foot care1. Current data indicate that on average, 50 to 60 percent of patients with diabetes have a semi-annual foot examination2,3.
Minorities at Higher Risk for Amputation
Analysis of a statewide California hospital discharge database indicated that in 1991, the age-adjusted incidence of diabetes-related lower extremity amputations per 10,000 people with diabetes was 95.3 in African Americans, 56.0 in non-Hispanic whites, and 44.4 in Hispanics. Amputations were 1.72 and 2.17 times more likely in African Americans compared with non-Hispanic whites and Hispanics, respectively. Hispanics had a higher proportion of amputations (82.7 percent) associated with diabetes as opposed to other causes of amputation, than did African Americans (61.6 percent) or non-Hispanic whites (56.8 percent)4.
Amputation rates in San Antonio, TX, were 66.5 per 10,000 for whites, 120.1 per 10,000 for Mexican Americans, and 181.2 per 10,000 for African Americans5. The incidence of amputations for Native Americans living on the Gila River Indian Reservation was 24.1 per 1,000 person-years compared to 6.5 per 1,000 person-years for the overall U.S. population with diabetes6. Increased awareness and identification of diabetes-related foot disease is especially important in these high-risk minority groups.