Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

Some ethnic groups are associated with lower socioeconomic status and some studieshave examined foot problems in relation to ethnicity. In a 2-year cohort of 1,666people (mean age 69 years; 52.0% Mexican American, 44.0% non-Hispanic whites,4.0% other ethnic group) with Type 2 diabetes (Lavery et al, 2003b), the incidence ofulceration, infection, amputation, and lower-extremity bypass was 68.4, 36.5, 5.9, and7.7 per 1,000 persons per year. The prevalence of peripheral sensory neuropathy withloss of protective sensation was 40.9% in Mexican Americans and 42.2% in non-Hispanic whites. Amputation incidence was higher in Mexican Americans than innon-Hispanic whites (7.4/1,000 v 4.1/1,000; OR 1.8, CI 1.2-2.7, p=0.003), while therewas no significant difference in the incidence of ulceration (p=0.1), foot infection(p=0.9) and lower-extremity bypass (p=0.3) between ethnic groups. MexicanAmericans were 3.8 times more likely to have a failed bypass which leaded to anamputation than non-Hispanic whites (75.0 v 44.0%; OR 3.8, CI 1.2-11.8, p=0.01).Young et al (2003) reported that individuals from certain ethnic minority groups hadan increased risk of LEA. Among 429,918 people with diabetes (mean age 64 years,97.4% male) who received primary care within the Veterans Affairs Health CareSystem, 3,289 people had an LEA during the study period (1 Oct 1997 to 10 Sept1998). Compared with people without amputation, amputees were more likely tobelong to a minority group and to have more comorbid conditions. Native Americanshad the highest risk of amputation (RR 1.74, CI 1.39-2.18), followed by AfricanAmericans (RR 1.41, CI 1.34-1.48) and Hispanics (RR 1.28, CI 1.20-1.38) comparedwith whites. Asians were more likely to have toe amputations and Native Americanswere more likely to have below-knee amputations compared with whites or otherethnicities.Karter et al (2002) reported diabetic complication rates in an ethnically diversepopulation (n=62,432) with diabetes which included Asians (12%), blacks (14%),Latinos (10), and whites (64%) in a 4-year observational study. Latinos were leastlikely (35%), followed by blacks (55%), to have more than a high school education.At baseline, self-reported peripheral neuropathy was 19% in Asians, 31% in Latinosand 32% in blacks and 32% in whites, respectively. From January 1995 to December1998, there were 574 hospitalisations for nontraumatic LEA procedures. The age- andsex-adjusted incidence rate was 10.7 (CI 9.2-12.3) per 1,000 person-years in blacks,9.2 (CI 8.6-9.9) in whites, 6.3 (CI 5.0-7.8) in Latinos and 5.9 (CI 4.7-7.2) in Asians.The incidence of LEA procedures was significantly lower in Asians than in whites,with a HR of 0.40 (CI .028-0.62); while there was no statistically significant blackwhiteand Latino-white difference for LEA (HR 0.84, CI 0.65-1.08, p=0.16; HR 0.85,CI 0.63-1.14, p=0.27).Australia’s Aboriginal and Torres Strait Islander peoples, a socioeconomicallydisadvantaged group, are especially likely to suffer many foot problems related todiabetes. Unfortunately there are no specific data relating to the management ofdiabetes related foot problems among socioeconomically disadvantaged people, andresearch in this area is urgently needed.98