In light of anecdotal evidence suggesting high rates of diabetes-related lower-extremity amputation rates in the Caribbean, Dr. Anselm J. M. Hennis from University of the West Indies, Bridgetown, Barbados and colleagues investigated the incidence of amputation and relevant risk factors in diabetic patients in Barbados.

The overall incidence of lower-extremity amputation among diabetics was 936 per 10,000 patients, the authors report, nearly identical to rates in blacks but three times higher than those in Caribbean migrants to the UK.

Amputation risk was higher among men and single persons, the report indicates, and the rate increased with duration of known diabetes, usual treatment with insulin, and glycosylated hemoglobin level.

Patients with amputations were more likely to have higher pulse rates and lower sitting systolic blood pressure, the researchers note, and amputees were more likely to have had previous foot ulcers or limb infections, sensorimotor neuropathy, and signs of peripheral vascular disease.

The lower-extremity amputation risk was nearly tripled by going barefoot (in men), doubled by wearing sneakers regularly to work (in women), increased fourfold by wearing sneakers to town, and doubled by wearing rubber thong sandals, the investigators report. Wearing fashion shoes was also associated with a fourfold increased risk of amputation.

In multivariate models, high-risk footwear was independently associated with a 2.5-fold increased risk of minor amputation and a 3.85-fold increased risk of major amputation, whereas daily self-examination of the feet was associated with an 80% reduced amputation risk.

"Given that the majority of amputees were known to the hospital system and many had previously been admitted with foot problems," the authors conclude, "targeted interventions may be a valuable strategy to reduce the burden of lower-extremity amputation in the Caribbean."

"Such a strategy would aim to improve footwear, particularly in those with diabetic foot disease, foot care through podiatric and surgical services (including greater use of limb revascularization), and promotion of early health care-seeking behavior," the investigators add.