title: Diabetic foot syndrome: evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes disease management cohort.
abstract: OBJECTIVE
  To report the incidence of diabetes-related lower-extremity complications in a cohort of patients enrolled in a diabetes disease management program.
  
  
  METHODS
  We evaluated screening results and clinical outcomes for the first 1,666 patients enrolled in a disease management program for a period of 24 months (50.3% men, aged 69.1 +/- 11.1 years).
  
  
  RESULTS
  The incidence of ulceration, infection, amputation, and lower-extremity bypass was 68.4, 36.5, 5.9, and 7.7 per 1,000 persons with diabetes per year. Amputation incidence was higher in Mexican Americans than in non-Hispanic whites (7.4/1,000 vs. 4.1/1,000; P = 0.003, odds ratio [OR] 1.8, 95% CI 1.2-2.7). The amputation-to-ulcer ratio was 8.7%. The incidence of Charcot arthropathy was 8.5/1,000 per year. Charcot was more common in non-Hispanic whites than in Mexican Americans (11.7/1,000 vs. 6.4/1,000; P = 0.0001, 1.8, 1.3-2.5). The prevalence of peripheral vascular disease was 13.5%, with no significant difference based on ethnicity (P = 0.3). There was not a significant difference in incidence of foot infection (P = 0.9), lower-extremity bypass (P = 0.3), or ulceration (P = 0.1) based on ethnicity. However, there were more failed bypasses in Mexican Americans (33%) than in non-Hispanic whites (7.1%). Mexican Americans were 3.8 times more likely to have a failed bypass (leading to an amputation) or be diagnosed as "nonbypassable" than non-Hispanic whites (75.0 vs. 44.0%; P = 0.01, 3.8, 1.2-11.8).
  
  
  CONCLUSIONS
  The incidence of amputation is higher in Mexican Americans, despite rates of ulceration, infection, vascular disease, and lower-extremity bypass similar to those of non-Hispanic whites. There may be factors associated with failed or failure to bypass that mandate further investigation.
authors.affiliation: Department of Surgery, Diabetex Research Group, Baltimore, Maryland, USA. lklavery@yahoo.com
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Lavery
authors.forename: David G
authors.initials: DG
authors.lastname: Armstrong
authors.forename: Robert P
authors.initials: RP
authors.lastname: Wunderlich
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tredwell
authors.forename: Andrew J M
authors.initials: AJ
authors.lastname: Boulton
mesh_terms: D017668:Age of Onset; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D016208:Databases, Factual; D003925:Diabetic Angiopathies / Q000453:epidemiology; D017719:Diabetic Foot / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D005530:Foot Deformities / Q000453:epidemiology; D006630:Hispanic or Latino; D006801:Humans; D015994:Incidence; D008297:Male; D014481:United States / Q000453:epidemiology; D044465:White People