Diabetic major amputation in Far North Queensland 1998-2008: what is the Gap for Indigenous patients?

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.