Diabetic major amputation in far north Queensland 1998-2008: What is the Gap for Indigenous patients?

摘要

Objective: To examine demographic and clinical characteristics of diabetic patients undergoing diabetes-related major amputation in Far North Queensland to identify those at risk. Design: A cohort was examined for differences between Indigenous and non-Indigenous groups in age, co-morbidities, indication for amputation and mortality. Attendance at the High Risk Foot Service was also reported. Setting: Far North Queensland. Participants: individuals with major amputations between 1998 and 2008. Main outcome measures: Diabetes-related major amputations and mortality. Results: Of the 143 individuals who underwent major amputation during the study period, 52% were Indigenous. On average, Indigenous amputees were 14 years younger than non-Indigenous amputees. There were more female Indigenous amputees compared with Indigenous male amputees. Indigenous amputees were more likely to suffer from chronic kidney disease (P<0.000) and reside in a remote community (P<0.000). Sepsis as an indication for amputation was more frequent in Indigenous subjects (P=0.019). There was no statistically significant difference in mortality related to the procedure between Indigenous and non-indigenous amputees. Conclusion: Indigenous patients with renal disease living in remote communities are at higher risk of developing limb-threatening diabetic foot complications. Further improvements in self-care, diabetes management and foot-care are required to reduce major amputation rates, particularly for those residing in remote areas.