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The Amputation Prevention Initiative

Emily A. Cook DPM, MPH1, Jeremy J. Cook DPM, MPH1, Magdala Peixoto Labre PhD, MPH2, Howard Givens MD, MPH3, and James J. DiResta DPM, MPH4
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  • 1 Division of Podiatric Surgery, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA.
  • | 2 Educational Services, Inc, Bethesda, MD.
  • | 3 US Air Force School of Aerospace Medicine, Brooks City-Base, TX.
  • | 4 Surgical Services, Anna Jacques Hospital, Newburyport, MA.
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Background

The Amputation Prevention Initiative is a project conducted jointly by the Massachusetts Public Health Association and the Massachusetts Podiatric Medical Society that seeks to study methods to reduce nontraumatic lower-extremity amputations from diabetes.

Methods

To determine the rate of diabetes-related lower-extremity amputations in Massachusetts and identify the groups most at risk, hospital billing and discharge data were analyzed. To examine the components of the diabetic foot examination routinely performed by general practitioners, surveys were conducted in conjunction with physician meetings in Massachusetts (n = 149) and in six other states (n = 490).

Results

The average age-adjusted number of diabetes-related lower-extremity amputations in 2004 was 30.8 per 100,000 and 5.3 per 1,000 diabetic patients in MA, with high-risk groups being identified as men and black individuals. Among the general practitioners surveyed in Massachusetts, only 2.01% reported routinely conducting all four key components of the diabetic foot examination, with 28.86% reporting not performing any components.

Conclusions

These findings suggest that many general practitioners may be failing to perform the major components of the diabetic foot examination believed to prevent foot ulcers and lower-extremity amputations.

Corresponding author: Emily A. Cook, DPM, MPH, Division of Podiatric Surgery, Mount Auburn Hospital, Harvard Medical School, 330 Mount Auburn St, Cambridge, MA 02138. (E-mail: ecook@mah.harvard.edu)