A scoping review of limb preservation interventions with primary care providers caring for US Indigenous patients with diabetes and peripheral artery disease

Abstract

Amputation disparities due to diabetes and peripheral artery disease occur among vulnerable and historically mistreated populations. In Oklahoma, some of the highest amputation rates occur in Indigenous residents. Knowing that primary care providers are often the first to tackle prevention and assess at-risk limbs, we sought to understand the historical efforts made by primary care providers in this high-risk population. This scoping review evaluates the literature to summarize prior amputation prevention interventions and their characteristics, including the outcome metrics used among Indigenous populations in the United States. We searched MEDLINE using a combination of Medical Subject Headings and keywords related to amputation, limb preservation, limb salvage, and American Indian and Indigenous health inequities or disparities and ethnicity. We conducted our final search on October 4, 2024, including articles in English and those that focused on primary care practice-based interventions. We excluded case reports, trauma- or oncologic-related amputations, or articles describing interventions not conducted in the United States. We identified 404 articles and 3 fit the review criteria. All interventions were analyses of programs to improve diabetes care. All interventions occurred between 1986 and 2001 and were multilevel in structure. Intervention strategies used included expanded infrastructure, provider and patient education, implementation of clinical workflow and provider metrics, community awareness projects, foot-care expertise and footwear, and field visits. No interventions specifically targeted peripheral artery disease. This scoping review identifies a significant contemporary gap in amputation reduction interventions among Indigenous populations in the United States and highlights multiple areas where interventions may be needed to combat ongoing amputation disparities for a high-risk population.