Multidisciplinary treatment of diabetic foot ulcers in Canadian Aboriginal and non-Aboriginal people

Rose, Greg; Duerksen, Frank; Trepman, Elly; Cheang, Mary; Simonsen, J. Neil; Koulack, Joshua; Fong, Hank; Nicolle, Lindsay E.; Embil, John M.

doi:10.1016/j.fas.2007.10.006

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Volume 14, Issue 2 , Pages 74-81, 2008

Multidisciplinary treatment of diabetic foot ulcers in Canadian Aboriginal and non-Aboriginal people

Greg Rose, MD
- Department of Medicine, Section of Infectious Diseases, University of Ottawa, Ottawa, Ontario, Canada
Frank Duerksen, MD, FRCSC
- Diabetic Foot and Complicated Wound Clinic, Health Sciences Centre, Winnipeg, Manitoba, Canada
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
Elly Trepman, MD
- Diabetic Foot and Complicated Wound Clinic, Health Sciences Centre, Winnipeg, Manitoba, Canada
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Orthopaedic Surgery, Grand Itasca Clinic & Hospital, Grand Rapids, MN, United States
Mary Cheang, MMath
- Department of Community Health Sciences, Statistical Consulting Unit, University of Manitoba, Winnipeg, Manitoba, Canada
J. Neil Simonsen, MD, FRCPC
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
Joshua Koulack, MD, FRCSC
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
Hank Fong, MD, FRCSC
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
Lindsay E. Nicolle, MD, FRCPC
- Diabetic Foot and Complicated Wound Clinic, Health Sciences Centre, Winnipeg, Manitoba, Canada
- Department of Medicine, Section of Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
John M. Embil, MD, FRCPC
- Diabetic Foot and Complicated Wound Clinic, Health Sciences Centre, Winnipeg, Manitoba, Canada
- Department of Medicine, Section of Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- Corresponding author at: Infection Control Unit, Health Sciences Centre, MS673-820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9 Canada. Tel.: +1 204 787 4654; fax: +1 204 787 4699.

Received 20 November 2006; received in revised form 15 October 2007; accepted 29 October 2007.

Abstract

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.

Keywords: Diabetes, Complications, Wound, Neuropathy