Rates Of Diabetes-Related Lower-Limb Amputation In Northwestern Ontario: An Incidence Study And Introduction Of A Standardized Diabetic Foot Ulcer Management Protocol

Introduction: First Nations populations in Canada have higher incidence rates of type 2 diabetes mellitus than the general population and also incur more frequent complications, including lower-leg amputation. Patients with diabetes who present with a foot ulcer are at high risk for macrovascular events, with a 5-year mortality rate of up to 50%.Methods: Using census and health administrative data, we reviewed the incidence of diabetes and rates of diabetes- related lower-limb amputation in 2010-2013 in the catchment area of the Sioux Lookout Meno Ya Win Health Centre in northwestern Ontario, which serves a largely First Nations population. We also describe a novel protocol for the management of diabetic foot ulcers.Results: The rate of lower-limb amputation was 7 times the Ontario average and was 3 times higher than in other areas of the province. The Sioux Lookout Diabetic Foot Ulcer Protocol supports timely vascular assessment for concurrent peripheral vascular disease in patients with diabetic foot ulcers.Conclusion: Patients with diabetes in the Sioux Lookout Meno Ya Win Health Centre catchment area appear to undergo below-knee amputation at a rate 3 times greater than in other Ontario regions. Patients with diabetic foot ulcers should be identified as being at high risk for other atherosclerotic events (e. g., myocardial infarction, cerebrovascular accident) and require aggressive risk-management strategies.