Reducing Disparities in Diabetes- Related Lower Extremity Amputations: Assessment and Prevention Efforts in South Carolina

Objective:To examine the trends in lower extremity amputations in persons with diabetes and the racial disparities associated with these amputations, To describe the amputation prevention efforts, focusing on foot care, in effect across South Carolina.  

Methods:Rates of amputations were determined using hospital discharge data.  Amputations per 1000 diabetes hospitalizations and age-adjusted amputation rates were calculated.  Prevention efforts were obtained by interviews with educators, health care providers and community liaisons.

Results:Hospitalizations for lower extremity amputations have decreased significantly.  Racial disparities are still significant.  Although black females are much more likely to have diabetes than other race/sex groups, black males have consistently the highest amputation rates.   African Americans with diabetes were 60% more likely to have a below-the-knee amputation, and 2.7 times more likely to have an above-the-knee amputation than Whites with diabetes. Aggressive efforts are underway to improve the quality of foot care.  Foot-care training, screening, and awareness are explained in a variety of settings, including physician and nurse training, physician’s offices, diabetes education classes, and the annual African American Diabetes Conference.

Conclusion:The aggressive efforts put in place in the past five years are beginning to pay off in lowered amputation rates.  However, much work is left to do.  Racial disparities have not disappeared, and amputation rates are consistently higher in African American males than in any other group.