Schraer Cynthia Dodgen, Weaver Daniel, Naylor Julien Louise, Provost Ellen, Mayer Ann Marie
Alaska Native Tribal Health Consortium, Diabetes Program, Anchorage 99508, USA.
Int J Circumpolar Health. 2004;63 Suppl 2:114-9. doi: 10.3402/ijch.v63i0.17869.
The prevalence of diabetes is increasing rapidly among Alaska's Indian, Eskimo and Aleut populations. Approximately half the Native people with diabetes have no road access to hospitals or physicians, presenting a challenge in the attempt to prevent lower extremity amputation as a complication. In late 1998 funding became available for diabetes prevention and treatment among Native Americans. The tribal health corporations in Alaska decided to use a portion of this funding to implement a high-risk foot program to decrease the amputation rate.
The program initially involved a surgical podiatrist who provided training to local staff and performed preventive and reconstructive surgery on several patients with impending amputations. The program then provided training for a physical therapist to become a certified pedorthist. This individual established the long-term maintenance phase of the program by conducting diabetic foot clinics routinely at the Alaska Native Medical Center, a referral center in Anchorage. He also travels to other regions of the state to provide training for village and hospital-based health care providers and to conduct field clinics. A system was established in a common database management program to track the patients' foot conditions. Patient education is emphasized.
The overall amputation incidence among all Alaska Native patients with diabetes decreased from 7.6/1,000 in the pre-program period (1996 to 1998) to 2.7/1,000 in the post-program period (1999-2001) (p<.001). The rate among Aleuts, who previously had the highest amputation incidence, decreased from 17.4/1,000 to 3.1/1,000 over the same time periods (p<.001). Among people who had had diabetes at least 10 years, the overall amputation incidence decreased from 16.4/1,000 to 6.8/1,000 (p=.021); among Aleuts the rate fell from 24.5/1,000 to 2.6/1,000 (p=.01).
Though longer follow-up is needed, these data suggest that even in populations living in isolated regions, diabetic amputations can be prevented by a coordinated system to identify high-risk feet and provide preventive treatment and education in the context of a comprehensive diabetes management program in an integrated health system.
在阿拉斯加的印第安人、爱斯基摩人和阿留申人群中，糖尿病的患病率正在迅速上升。大约一半患有糖尿病的原住民无法通过公路前往医院或就医，这给预防作为并发症的下肢截肢带来了挑战。1998年末，有资金可用于美国原住民的糖尿病预防和治疗。阿拉斯加的部落健康机构决定将部分资金用于实施一项高危足部项目，以降低截肢率。
该项目最初由一名外科足病医生参与，他为当地工作人员提供培训，并为几名即将接受截肢手术的患者进行预防性和重建性手术。该项目随后为一名物理治疗师提供培训，使其成为一名认证足病矫形师。此人通过在安克雷奇的转诊中心阿拉斯加原住民医疗中心定期开展糖尿病足诊所，确立了该项目的长期维护阶段。他还前往该州的其他地区，为乡村和医院的医疗保健人员提供培训，并开展现场诊所。在一个通用数据库管理程序中建立了一个系统，以跟踪患者的足部状况。强调患者教育。
所有阿拉斯加原住民糖尿病患者的总体截肢发生率从项目实施前（1996年至1998年）的7.6/1000降至项目实施后（1999 - 2001年）的2.7/1000（p<0.001）。阿留申人此前截肢发生率最高，在同一时期从17.4/1000降至3.1/1000（p<0.001）。在患有糖尿病至少10年的人群中，总体截肢发生率从16.4/1000降至6.8/1000（p = 0.021）；阿留申人的发生率从24.5/1000降至2.6/1000（p = 0.01）。
尽管需要更长时间的随访，但这些数据表明，即使在生活在偏远地区的人群中，通过一个协调的系统来识别高危足部，并在综合卫生系统的全面糖尿病管理项目背景下提供预防性治疗和教育，糖尿病截肢是可以预防的。
