Details

Autor(en) / Beteiligte

• Rose, Greg, MD
• Duerksen, Frank, MD, FRCSC
• Trepman, Elly, MD
• Cheang, Mary, MMath
• Simonsen, J. Neil, MD, FRCPC
• Koulack, Joshua, MD, FRCSC
• Fong, Hank, MD, FRCSC
• Nicolle, Lindsay E., MD, FRCPC
• Embil, John M., MD, FRCPC

Titel

Multidisciplinary treatment of diabetic foot ulcers in Canadian Aboriginal and non-Aboriginal people

Ist Teil von

• Foot and ankle surgery, 2008, Vol.14 (2), p.74-81

Ort / Verlag

Amsterdam: Elsevier Ltd

Erscheinungsjahr

2008

Link zum Volltext

Quelle

Access via ScienceDirect (Elsevier)

Beschreibungen/Notizen

• Abstract Background Diabetic foot ulcers are a major cause of morbidity and mortality. This study evaluated the clinical outcomes in Canadian non-Aboriginal and Aboriginal diabetic patients with foot ulcers managed at a multidisciplinary, tertiary care diabetic foot clinic. Methods A retrospective review of medical records was done for 325 patients receiving care during a 2-year period. All patients were followed at least 1 year after the initial visit. Results There were 224 (69%) non-Aboriginal and 101 (31%) Aboriginal patients with 697 foot ulcers. At the initial office visit, 204 (63%) patients had lesions in Wagner grades 2–4. At the most recent evaluation (average, 79 ± 73 weeks after initial clinic visit), 190 (58%) patients were rated as having a good outcome (either healed or healing), but a poor outcome (static, progression, amputation, or death) was noted in 135 (42%) patients. At the most recent evaluation, the majority of the 697 ulcers that were noted at the initial or subsequent clinic visits were healed. Aboriginal patients had a shorter average time from initial clinic visit to major lower extremity amputation (Aboriginal, 50 ± 64 weeks; non-Aboriginal, 62 ± 56 weeks; P < 0.01). Residence in a rural or reserve community also correlated with shorter average time from initial clinic visit to major lower extremity amputation (rural or reserve, 45 ± 56 weeks; urban, 66 ± 61 weeks; P < 0.002). When controlled for non-urban residence, Aboriginal ethnicity was not associated with poorer clinical outcome. Earlier major lower extremity amputation was significantly associated with non-urban residence, Aboriginal ethnicity, and arterial insufficiency. Poor clinical outcome was significantly associated with being referred with a lesion present, age greater than 60 years, prior lower extremity amputation or revascularization, arterial insufficiency, more than one lesion on initial presentation, longer duration of type 2 diabetes, and a higher initial Wagner grade for the most advanced lesion. Conclusions A multidisciplinary diabetic foot clinic may be successful in treating diabetic foot ulcers in Aboriginal and non-Aboriginal people. However, the frequency of poor outcome is high, consistent with the high prevalence of associated significant risk factors in this population.