Diabetic major amputation in Far North Queensland 1998-2008: what is the Gap for Indigenous patients?

Objective: To examine demographic and clinical characteristics of diabetic patients undergoing diabetes-related major amputation in Far North Queensland to identify those at risk.

Design: A cohort was examined for differences between Indigenous and non-Indigenous groups in age, co-morbidities, indication for amputation and mortality. Attendance at the High Risk Foot Service was also reported.

Setting: Far North Queensland.

Participants: individuals with major amputations between 1998 and 2008.

Main Outcome Measures: Diabetes-related major amputations and mortality.

Results: Of the 143 individuals who underwent major amputation during the study period, 52% were Indigenous. On average, Indigenous amputees were 14 years younger than non-Indigenous amputees. There were more female Indigenous amputees compared with Indigenous male amputees. Indigenous amputees were more likely to suffer from chronic kidney disease (P < 0.000) and reside in a remote community (P < 0.000). Sepsis as an indication for amputation was more frequent in Indigenous subjects (P = 0.019). There was no statistically significant difference in mortality related to the procedure between Indigenous and non-indigenous amputees.

Conclusion: Indigenous patients with renal disease living in remote communities are at higher risk of developing limb-threatening diabetic foot complications. Further improvements in self-care, diabetes management and foot-care are required to reduce major amputation rates, particularly for those residing in remote areas.