BACKGROUND: There is little information available about the profile of lower extremity morbidity in diabetic patients with end-stage renal disease (ESRD) in the Canadian Aboriginal and non-Aboriginal population. METHOD: A retrospective review of medical records in 127 diabetic patients on hemodialysis at a tertiary health care center was performed. Patient interviews and physical examinations were performed in 77 of these patients (36 Aboriginal, 41 non-Aboriginal), and followup evaluation was done in 39 patients at an average of 1 year later. RESULTS: Aboriginal patients were an average of 7 years younger than non-Aboriginal patients. Comorbidities of diabetes and ESRD were frequent. Peripheral neuropathy and inability to occlude the vessels were present in the majority of feet. Lower extremity complications were frequent, including prior foot ulcer in the majority of patients and an amputation in more than one fourth of the patients. Aboriginal patients had a significantly greater frequency of prior foot ulcer, mean number of foot ulcers per patient, amputation, prior osteomyelitis, and Charcot foot than non-Aboriginal patients. Almost all patients were at risk for future foot ulcer, but many patients did not inspect their feet daily. Home care was significantly less frequently available for Aboriginal than non-Aboriginal patients. The majority of patients had inadequate custom or prefabricated shoes and did not wear insoles on the day of examination. Aboriginal patients cited financial cost, insufficient family support, and language barriers as reasons for inadequate foot care and footwear more frequently than non-Aboriginal subjects. A significantly smaller frequency of Aboriginal patients had good knowledge of footwear or diet than non-Aboriginal patients. CONCLUSIONS: Lower extremity complications were significantly more frequent in Aboriginal than non-Aboriginal diabetic patients with ESRD. Financial cost and knowledge deficit were barriers to adequate foot care and footwear. These findings support the need for a formal foot care and footwear program for this high-risk population.
BACKGROUND: There is little information available about the profile of lower extremity morbidity in diabeticpatients with end-stage renal disease (ESRD) in the Canadian Aboriginal and non-Aboriginal population. METHOD: A retrospective review of medical records in 127 diabeticpatients on hemodialysis at a tertiary health care center was performed. Patient interviews and physical examinations were performed in 77 of these patients (36 Aboriginal, 41 non-Aboriginal), and followup evaluation was done in 39 patients at an average of 1 year later. RESULTS: Aboriginal patients were an average of 7 years younger than non-Aboriginal patients. Comorbidities of diabetes and ESRD were frequent. Peripheral neuropathy and inability to occlude the vessels were present in the majority of feet. Lower extremity complications were frequent, including prior foot ulcer in the majority of patients and an amputation in more than one fourth of the patients. Aboriginal patients had a significantly greater frequency of prior foot ulcer, mean number of foot ulcers per patient, amputation, prior osteomyelitis, and Charcot foot than non-Aboriginal patients. Almost all patients were at risk for future foot ulcer, but many patients did not inspect their feet daily. Home care was significantly less frequently available for Aboriginal than non-Aboriginal patients. The majority of patients had inadequate custom or prefabricated shoes and did not wear insoles on the day of examination. Aboriginal patients cited financial cost, insufficient family support, and language barriers as reasons for inadequate foot care and footwear more frequently than non-Aboriginal subjects. A significantly smaller frequency of Aboriginal patients had good knowledge of footwear or diet than non-Aboriginal patients. CONCLUSIONS: Lower extremity complications were significantly more frequent in Aboriginal than non-Aboriginal diabeticpatients with ESRD. Financial cost and knowledge deficit were barriers to adequate foot care and footwear. These findings support the need for a formal foot care and footwear program for this high-risk population.
Authors: Christopher Bonneau; Nadine R. Caron; Mohamad A. Hussain; Ahmed Kayssi; Subodh Verma; Mohammed Al-Omran Journal: Can J Surg Date: 2018-10-01 Impact factor: 2.089
Authors: Jason A McVicar; Alana Poon; Nadine R Caron; M Dylan Bould; Jason W Nickerson; Nora Ahmad; Donna May Kimmaliardjuk; Chelsey Sheffield; Caitlin Champion; Daniel I McIsaac Journal: CMAJ Date: 2021-05-17 Impact factor: 8.262
Authors: Agbor Ndip; Lawrence A Lavery; Javier Lafontaine; Martin K Rutter; Anand Vardhan; Loretta Vileikyte; Andrew J M Boulton Journal: Diabetes Care Date: 2010-01-12 Impact factor: 19.112
Authors: Michelle R Kaminski; Anita Raspovic; Lawrence P McMahon; Bircan Erbas; Karl B Landorf Journal: J Foot Ankle Res Date: 2015-09-18 Impact factor: 2.303
Authors: Jason A McVicar; Alana Poon; Nadine R Caron; M Dylan Bould; Jason W Nickerson; Nora Ahmad; Donna May Kimmaliardjuk; Chelsey Sheffield; Caitlin Champion; Daniel I McIsaac Journal: CMAJ Date: 2021-08-23 Impact factor: 8.262