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Diabetes Care in the News

Geriatric Times

May/June 2002

Vol. III

Issue 3

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Is Ethnicity a Factor in Extremity Amputation?

African Americans have two to three times the risk of diabetes-related lower extremity amputation (LEA) compared with white Americans. This may be due to differences in care or pathophysiological characteristics. A recently published study (Arch Intern Med 2002;162[1]:73-78) that determined diabetes-related amputations rates in African Caribbeans versus Europeans in the United Kingdom, where health care treatment is more equitable, seemed to point to access to care as the cause.

Sandra Leggetter, M.Sc., and colleagues conducted an incidence and case-control study of all diabetes-related amputations performed in London between 1992 and 1997. The control group had diabetes but no amputation. Results revealed that, in contrast to the same type of study in the United States, there was no ethnic difference in diabetes-related LEA in women. In men, however, amputation risk in African Caribbeans was one-third the risk for Europeans. Amputation rates were 147 per 100,000 and 219 per 100,000 in African Caribbeans and Europeans, respectively. Case-control analyses were performed on 178 cases and 350 controls. The unadjusted odds ratio comparing African Caribbeans with Europeans in men was 0.31 (95% CI [confidence interval], 0.17-0.57; p<0.001), and in women was 0.97 (95% CI, 0.49-1.85; p=0.9).

The researchers concluded, "The higher rates of diabetes-related amputation in people of black African descent in the United States are not confirmed in this UK study, which may support the hypothesis that high rates in the United States can be accounted for by inequalities in access to health care. Both the incident rates and the case control analysis indicate that amputation risk is no higher in people of black African descent in the United Kingdom in people with diabetes, and may even be lower" -- AV

Glucose Levels Respond to Stress Management

In research studies, the experience of stress has been linked with elevated levels of glucose, which can have serious consequences for patients with diabetes. While some intensive stress-management interventions have been shown to improve glycemic control in patients with type 2 diabetes, such strategies are often costly and impractical for outpatients.

Investigators at Duke University Medical Center in Durham, N.C., led by Richard Surwit, Ph.D., designed a trial to test the efficacy and feasibility of low-cost, outpatient group stress-management training for patients with type 2 diabetes (Diabetes Care 25[1]:30-34). In the first two months of the study, patients in the control arm (n=34) attended five weekly meetings involving basic diabetes education regarding facts, complications, treatments, self-care and healthy eating. Stress-management patients (n=38) received diabetes education as well as instruction in progressive muscle relaxation, cognitive and behavioral skills for recognizing and reducing physiological stress levels, and the health consequences of stress.

Changes in HbA_1c levels and glucose regulation were measured at two, four, six and 12 months. It was not until the 12-month data-collection point that a statistically significant benefit of stress management became evident. Patients in the treatment group showed a decrease in HbA_1c levels over time, while an increase occurred in patients receiving diabetes education alone. The authors commented that the 0.5% difference in HbA_1c levels between groups was gradual and modest, but noted that such a change is sufficient to reduce risk for microvascular complications from diabetes -- JH