Diabetes Complications and Mortality Among Alaska Natives: 8 Years of Observation

Schraer, Cynthia D; Adler, Amanda I; Mayer, Ann Marie; Halderson, Karen; Trimble, Brian

doi:10.2337/diacare.20.3.314

Cited by 43 publications

(50 citation statements)

References 14 publications

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“…A decreasing incidence has been reported from many geographic areas where various interventions have been applied (Humphrey et al1996, Schraer et al 1997, Rith-Najarian et al 1998, Calle-Pascual et al 2001, Holstein et al 2001. These studies are usually not populationbased, and have shown a decreasing incidence in a short-term perspective only (Larsson and (Feinglass et al 1999).…”

Section: Discussionmentioning

confidence: 99%

“…Several reports from single centers, usually not population-based, have since reported a substantially reduced incidence of major lower extremity amputations in patients with diabetes mellitus following the implementation of various multidisciplinary programs for prevention and treatment of diabetic foot ulcers , Humphrey et al 1996, Schraer et al 1997, Rith-Najarian et al 1998, Calle-Pascual et al 2001, Holstein et al 2001). However, an unchanged or increased incidence of lower-limb amputations has been described by several other authors (Morris et al 1998, Stiegler et al 1998, Pohjolainen and Alaranta 1999, Trautner et al 2001.…”

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confidence: 99%

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Sustained reduction in major amputations in diabetic patients: 628 amputations in 461 patients in a defined population over a 20-year period

et al. 2008

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Sustained reduction in major amputations in diabetic patients: 628 amputations in 461 patients in a defined population over a 20-year period

et al. 2008

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“…The 10 year risk of LEA in diabetes varies widely from approximately 1% in Alaskan Natives [44] Barbadians [45] and some UK sites [46]. If lowering blood glucose translates into a lower incidence of LEA, for a population with a 10 year incidence of LEA of 5% [47] and an average HbA 1c of 9.5%, an improvement to an average HbA 1c of 7.5% would reduce the rate of LEA to roughly 3%, all other things being equal.…”

Section: Discussionmentioning

confidence: 99%

Association between glycated haemoglobin and the risk of lower extremity amputation in patients with diabetes mellitus—review and meta-analysis

et al. 2010

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Aims/hypothesis Diabetes increases the risk of lower extremity amputation (LEA). Although epidemiological studies report positive associations between glycaemia and LEA, the magnitude of the risk is not adequately quantified and clinical trials to date have not provided conclusive evidence about glucose lowering and LEA risk. We synthesised the available prospective epidemiological data on the association between glycaemia measured by HbA 1c and the risk of LEA in individuals with diabetes. Methods We searched electronic databases and reference lists of relevant articles. We considered prospective epidemiological studies that had measured HbA 1c level and assessed LEA as an outcome among diabetic individuals without acute foot ulcerations or previous history of amputation. Of 2,548 citations identified, we included 14 studies comprising 94,640 participants and 1,227 LEA cases. We abstracted data using standardised forms and obtained data from investigators when required. Data included characteristics of study populations, HbA 1c assay methods, outcome and covariates. Study-specific relative risk estimates were pooled using random-effects model meta-analysis; heterogeneity was explored with metaregression analyses. Results The overall RR for LEA was 1.26 (95% CI 1.16-1.36) for each percentage point increase in HbA 1c . There was considerable heterogeneity across studies (I 2 76%, 67-86%; p<0.001), which was not accounted for by recorded study characteristics. The estimated RR was 1.44 (95% CI 1.25-1.65) for type 2 diabetes and 1.18 (95% CI 1.02-1.38) for type 1 diabetes; however, the difference was not statistically significant (p=0.09). We found no strong evidence for publication bias. Conclusions/interpretation There is a substantial increase in risk of LEA associated with glycaemia in individuals with diabetes. In the absence of conclusive evidence from trials, this paper provides further epidemiological support for glucose-lowering as a strategy to reduce amputation in a population without acute foot ulceration or former amputation; it also provides disease modellers with estimates to assess the overall burden of hyperglycaemia.

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“…29,30 Within Alaska, the prevalence of metabolic syndrome in two regions was higher than rates for U.S. whites. The rate may currently be low in western Alaska, but given the historical trend toward increasing diabetes and increasing obesity, once might expect the rate to increase in the future.…”

Section: Figmentioning

confidence: 99%

Metabolic Syndrome: Prevalence among American Indian and Alaska Native People Living in the Southwestern United States and in Alaska

Schumacher

Ferucci

Lanier

et al. 2008

Metabolic Syndrome and Related Disorders

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Background: Metabolic syndrome occurs commonly in the United States. The purpose of this study was to measure the prevalence of metabolic syndrome among American Indian and Alaska Native people. Methods: We measured the prevalence rates of metabolic syndrome, as defined by the National Cholesterol Education Program, among four groups of American Indian and Alaska Native people aged 20 years and older. One group was from the southwestern United States (Navajo Nation), and three groups resided within Alaska. Prevalence rates were age-adjusted to the U.S. adult 2000 population and compared to rates for U.S. whites (National Health and Nutrition Examination Survey [NHANES] 1988[NHANES] -1994. Results: Among participants from the southwestern United States, metabolic syndrome was found among 43.2% of men and 47.3% of women. Among Alaska Native people, metabolic syndrome was found among 26.5% of men and 31.2% of women. In Alaska, the prevalence rate varied by region, ranging among men from 18.9% (western Alaska) to 35.1% (southeast), and among women from 22.0% (western Alaska) to 38.4 % (southeast). Compared to U.S. whites, American Indian/Alaska Native men and women from all regions except western Alaska were more likely to have metabolic syndrome; men in western Alaska were less likely to have metabolic syndrome than U.S. whites, and the prevalence among women in western Alaska was similar to that of U.S. whites. Conclusion: The prevalence rate of metabolic syndrome varies widely among different American Indian and Alaska Native populations. Differences paralleled differences in the prevalence rates of diabetes.

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Diabetes Complications and Mortality Among Alaska Natives: 8 Years of Observation

Abstract: We conclude that diabetes is increasing in Alaska Natives, who are experiencing both the microvascular and macrovascular complications of diabetes. The incidence of LEA and ESRD show some evidence of a decrease after intervention efforts.

Cited by 43 publications

References 14 publications

Sustained reduction in major amputations in diabetic patients: 628 amputations in 461 patients in a defined population over a 20-year period

Sustained reduction in major amputations in diabetic patients: 628 amputations in 461 patients in a defined population over a 20-year period

Association between glycated haemoglobin and the risk of lower extremity amputation in patients with diabetes mellitus—review and meta-analysis

Metabolic Syndrome: Prevalence among American Indian and Alaska Native People Living in the Southwestern United States and in Alaska

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