Multidisciplinary treatment of diabetic foot ulcers in Canadian Aboriginal and non-Aboriginal people.
BACKGROUND
Diabetic foot ulcers are a major cause of morbidity and mortality. This study evaluated the clinical outcomes in Canadian non-Aboriginal and Aboriginal diabetic patients with foot ulcers managed at a multidisciplinary, tertiary care diabetic foot clinic.


METHODS
A retrospective review of medical records was done for 325 patients receiving care during a 2-year period. All patients were followed at least 1 year after the initial visit.


RESULTS
There were 224 (69%) non-Aboriginal and 101 (31%) Aboriginal patients with 697 foot ulcers. At the initial office visit, 204 (63%) patients had lesions in Wagner grades 2-4. At the most recent evaluation (average, 79+/-73 weeks after initial clinic visit), 190 (58%) patients were rated as having a good outcome (either healed or healing), but a poor outcome (static, progression, amputation, or death) was noted in 135 (42%) patients. At the most recent evaluation, the majority of the 697 ulcers that were noted at the initial or subsequent clinic visits were healed. Aboriginal patients had a shorter average time from initial clinic visit to major lower extremity amputation (Aboriginal, 50+/-64 weeks; non-Aboriginal, 62+/-56 weeks; P<0.01). Residence in a rural or reserve community also correlated with shorter average time from initial clinic visit to major lower extremity amputation (rural or reserve, 45+/-56 weeks; urban, 66+/-61 weeks; P<0.002). When controlled for non-urban residence, Aboriginal ethnicity was not associated with poorer clinical outcome. Earlier major lower extremity amputation was significantly associated with non-urban residence, Aboriginal ethnicity, and arterial insufficiency. Poor clinical outcome was significantly associated with being referred with a lesion present, age greater than 60 years, prior lower extremity amputation or revascularization, arterial insufficiency, more than one lesion on initial presentation, longer duration of type 2 diabetes, and a higher initial Wagner grade for the most advanced lesion.


CONCLUSIONS
A multidisciplinary diabetic foot clinic may be successful in treating diabetic foot ulcers in Aboriginal and non-Aboriginal people. However, the frequency of poor outcome is high, consistent with the high prevalence of associated significant risk factors in this population.
Rose
Greg
G
Department of Medicine, Section of Infectious Diseases, University of Ottawa, Ottawa, Ontario, Canada.
Duerksen
Frank
F
Trepman
Elly
E
Cheang
Mary
M
Simonsen
J Neil
JN
Koulack
Joshua
J
Fong
Hank
H
Nicolle
Lindsay E
LE
Embil
John M
JM
D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D017719:Diabetic Foot / Q000145:classification / Q000208:ethnology* / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007198:Indians, North American; D008297:Male; D008350:Manitoba; D008875:Middle Aged; D010348:Patient Care Team; D012189:Retrospective Studies; D016896:Treatment Outcome; D044465:White People; D014945:Wound Healing