Diabetic foot syndrome - Evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes disease management cohort

被引:321
作者
Lavery, LA
Armstrong, DG
Wunderlich, RP
Tredwell, J
Boulton, AJM
机构
[1] Diabet Res Grp, Dept Surg, Baltimore, MD USA
[2] So Arizona Vet Affairs Med Ctr, Dept Orthopaed, Tucson, AZ USA
[3] Loyola Univ, Dept Orthoped Surg & Rehabil, Chicago, IL 60611 USA
[4] Manchester Royal Infirm, Dept Med, Manchester M13 9WL, Lancs, England
[5] Univ Miami, Sch Med, Dept Med, Miami, FL 33152 USA
关键词
D O I
10.2337/diacare.26.5.1435
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE - To report the incidence of diabetes-related lower-extremity complications in a cohort of patients enrolled in a diabetes disease management program. RESEARCH DESIGN AND METHODS - We evaluated screening results and clinical outcomes for the first 1,666 patients enrolled in a disease management program for 1 period of 24 months (50.3% men, aged 69.1 +/- 11.1 years). RESULTS - The incidence of ulceration, infection, amputation, and lower-extremity bypass was 68.4, 36.5, 5.9, and 7.7 per 1,000 persons with diabetes per year. Amputation incidence was higher in Mexican Americans than in non-Hispanic whites (7.4/1,000 vs. 4.1/1,000; P = 0.003, odds ratio [OR] 1.8, 95% CI 1.2-2.7). The amputation-to-ulcer ratio was 8.7%. The incidence of Charcot arthropathy was 8.5/1,000 per year, Charcot was more common in non-Hispanic whites than in Mexican Americans (11.7/1,000 vs. 6.4/1,000, P = 0.0001, 1 8, 13-2.5) The prevalence of peripheral vascular disease was 13.5%, with no significant difference based on ethnicity (P = 0.3). There was not a significant difference in incidence Of foot infection (P = 0.9), lower-extremity bypass (P = 0.3), or ulceration (P = 0.1) based on ethnicity. However, there were more failed bypasses in Mexican Americans (33%) than in non-Hispanic Whites (7.1%). Mexican Americans were 3.8 times more likely to have a failed bypass (leading to an amputation) or be diagnosed as "nonbypassable" than non-Hispanic whites (75.0 vs. 44.0%, P = 0.01, 3.8, 1.2-11.8). CONCLUSIONS - The incidence of amputation is higher in Mexican Americans, despite rates of ulceration, infection, vascular disease, and lower-extremity bypass similar to those of non-Hispanic whites. There may be factors associated with failed or Failure to bypass that mandate further investigation.
引用
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页码:1435 / 1438
页数:4
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