Diabetic complications among American Indians of Washington, Oregon, and Idaho. Prevalence of retinopathy, end-stage renal disease, and amputations.
OBJECTIVE
To estimate the prevalence of severe diabetic complications.


METHODS
We surveyed the data systems of the IHS and local care providers to identify all AI/AN people with any of three diabetic complications: retinopathy needing one or more laser treatments, ESRD needing dialysis, and one or more LEAs. We calculated prevalence rates that were sex-age adjusted to the U.S. population for total sample, each community, gender, and culture area.


RESULTS
Of the population-based complete sample with diabetes, 1.7% had retinopathy, 1% ESRD, and 4% LEA. Complication rates among the culture areas were not statistically different. The LEA rate among diabetic men (5.8%) was higher than that among women (2.3%). The odds ratio was 2.2 (95% CI 1.2-4.2). One community had an extraordinarily high LEA rate of 16%.


CONCLUSIONS
This study showed that IHS can use its data systems to estimate prevalence of diabetic complications and identify population groups with higher prevalence rates. The data led the IHS clinic with the high LEA rate to start a program to prevent amputations. We suggest quality assurance activities based on the methods of this study.
Freeman
W L
WL
Research Program, Indian Health Service Office of Health Program Research and Development, Tucson, Arizona.
Hosey
G M
GM
D000367:Age Factors; D000671:Amputation, Surgical; D003710:Demography; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007061:Idaho / Q000453:epidemiology; D007198:Indians, North American; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D016017:Odds Ratio; D009922:Oregon / Q000453:epidemiology; D015995:Prevalence; D014861:Washington / Q000453:epidemiology