Explanations for the high risk of diabetes-related amputation in a Caribbean population of black african descent and potential for prevention.
OBJECTIVE
Diabetes-related lower-extremity amputation (LEA) rates are elevated in blacks compared with whites in the U.S., but are lower in African Caribbeans in the U.K., whereas anecdotal reports suggest high rates in the Caribbean. We aimed to establish the incidence and risk factors for diabetes-related LEA in a Caribbean population.


METHODS
We conducted an incident and prospective case-control study of case patients (individuals with diabetes having a LEA) and community-based control subjects (individuals with diabetes without a LEA) in Barbados, West Indies. Participants completed an interview and examination of risk factors for amputation, including footwear use.


RESULTS
The overall 1-year incidence of LEA (n = 223) was 173 per 10(5) population and 936 per 10(5) population with diabetes (557 per 10(5) for minor amputation and 379 per 10(5) for major amputation). Women had higher amputation rates than those reported in the Global Lower Extremity Amputation Study, apart from the U.S. Navajo population. Independent risk factors for all diabetes-related LEAs were poor footwear (odds ratio [OR] 2.71 [95% CI 1.23-5.97]), elevated GHb (1.40 per percent increase [1.26-1.57]), peripheral neuropathy (1.05 per volt increase [1.03-1.08]), and peripheral vascular disease.


CONCLUSIONS
Diabetes LEA rates in Barbados are among the highest in the world. Inadequate footwear independently tripled amputation risk. Education of professionals and patients, particularly about footwear and foot care, coupled with improved diabetes clinical care, is key to reducing amputation risk in this population.
Hennis
Anselm J M
AJ
Chronic Disease Research Centre, Tropical Medicine Research Institute, University of the West Indies, Jemmott's Lane, Bridgetown, Barbados, West Indies. ahennis@caribsurf.com
Fraser
Henry S
HS
Jonnalagadda
Ramesh
R
Fuller
John
J
Chaturvedi
Nish
N
D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D001460:Barbados; D044383:Black People / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D003920:Diabetes Mellitus; D003925:Diabetic Angiopathies; D003929:Diabetic Neuropathies; D005260:Female; D006801:Humans; D015994:Incidence; D007866:Leg; D008297:Male; D010523:Peripheral Nervous System Diseases; D011446:Prospective Studies; D012307:Risk Factors; D012775:Shoes