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.
Bemidji Area Indian Health Service, Diabetes Programme, Minnesota, USA.
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Rith-Najarian
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Dannels
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Acton
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