Preventing amputations from diabetes mellitus: the Indian Health Service experience.
With the heavy burden of diabetes mellitus among American Indians and Alaskan Natives, lower-extremity amputation (LEA) has become a common complication. Rates of diabetes-related LEA are 2-3 times those observed in other diabetic populations. During the past 12 years, the Indian Health Service (IHS) has made LEA prevention a public health priority. From 1988 to 1992 screening criteria based on simple examinations were developed and validated in primary care Settings. Prevention efforts have focused on targeting high-risk individuals for self-care foot education, provision of protective footwear, and routine podiatry care. Follow-up studies in Alaska and northern Minnesota saw 25-50% reductions in LEA rates associated with these interventions. In settings where these efforts were augmented with system changes, such as team coordination, patient-tracking systems, comprehensive footcare practice guidelines, flowsheets, and outreach programmes, LEA incidence was reduced by 50-75%. Efforts are currently underway to disseminate system-based approaches for comprehensive diabetic footcare and to expand the availability of foot care resources to tribal communities served by the IHS.
Rith-Najarian
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Bemidji Area Indian Health Service, Diabetes Programme, Minnesota, USA.
Dannels
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Acton
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D000413:Alaska; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D017719:Diabetic Foot / Q000208:ethnology* / Q000517:prevention & control / Q000601:surgery*; D006303:Health Services, Indigenous / Q000592:standards; D006801:Humans; D015994:Incidence; D007198:Indians, North American; D010353:Patient Education as Topic; D011032:Podiatry; D012307:Risk Factors; D012648:Self Care; D014481:United States; D016549:United States Indian Health Service