Disparities in lower extremity amputation among native americans with diabetic foot ulcerations

It is a well-documented declaration that the Native American (NA)/ American Indian (AI) population is disproportionately affected by many chronic conditions. Among the chronic and often fatal ailments, diabetes mellitus (DM) is a prevailing diagnosis [1]. According to the 2017 American Diabetes Association, DM is responsible for significant deaths and is a substantial cost to society at $327 billion USD in the United States (US) [2]. Complications of DM include peripheral artery disease (PAD), a macrovascular complication, and peripheral neuropathy (PN), a microvascular condition, which in turn cascade into other adverse health outcomes [3,4]. Impaired vascular flow and loss of sensitivity to the extremities, particularly to the feet, likewise increases risk of diabetic foot ulceration (DFU) [3,4]. As a consequence of an infected foot ulceration and subsequent osteomyelitis or gangrene, patients may undergo lower extremity amputation (LEA) [4,5]. DFU not only limits mobility and causes pain and discomfort, but foot ulceration may even increase mortality rates and reduce life expectancy [6,7]. The rate of recurrence for DFU within 1 year is roughly 40%, about 60% within 3 years, and 65% within 5 years [8].