Patients with diabetes are 15 to 46 times at greater risk of lower extremity amputation than those without. Amputations are associated with increased risk of premature death, additional amputations within 3-5 year, and a substantial financial cost to society, the patient themselves and their families.
The cost of amputation is conservatively estimated at 1.6 billion dollars per year without consideration of physician fees, prosthetic devices or rehabilitation costs.
Native Americans with diabetes are 2-5 times more likely to have lower extremity amputations compared to the general populace with diabetes. In fact, diabetic subjects in a 1982- 1987 study between the ages of 14-44 had a 158 fold increase in the risk of first lower extremity amputation compared with non-diabetic subjects in the same age group.
Infected ulcers of the diabetic foot are the number one cause of lower extremity amputations. 65% of the ulcerations that lead to amputation begin at the toes. Treatment of the infected foot accounts for 20 - 40% of all hospital admissions. Frequently, patients admitted with infected ulcers are not correctly evaluated and treatment is often inadequate causing further increased risk of amputation.
From Dr. Kham Vay Ung's experience, after working extensively with many Native American tribes, the vast majority of amputations are unnecessary and can be prevented. After one limb is amputated, the contra-lateral limb is often amputated within a year and the patient is usually dead within 2 years. The death comes sooner with age 55 and older.
From a 3-year USPHS grant, a pilot diabetic foot program was established in the Winebago IHS, the amputation rate was reduced from an average of 14-16 per year to zero. This same program was established on several reservations with drastic success. The success of these programs can be attributed to aggressive intervention, frequent preventive treatment including regular foot exams, diabetic foot education, specialized foot ware inserts and continuing evaluation of other complications. These programs have proven that lower limb amputations can be prevented.
