DIABETES

MELLITUS is the most common under-lying cause of lower-extremity amputation in the United States and Europe. Approximately 120,000 nontraumatic amputations are done each year in the United States. Of these ampu-tations, 45 % to 83 % involve diabetes mellitus.1-3 Diabetes-related amputations are an important public health issue because many amputations can be prevented when high-risk patients receive preventive medical care.4-6 Prevention of diabetes-related amputations is a specific goal outlined by state and federal public health departments, as well as the Veterans Ad-ministration and the Health Resources and Services Administration. One objective of Healthy People 2000,7 a national strategy to improve the health of the American people, is to reduce the incidence of diabetes-related amputations from 82 to 49 per 10,000 persons per year. One of the first steps to develop pro-grams to prevent amputations is to identify high-risk populations,8,9 so programs can be implemented where they are needed most. Based on the disproportionately high preva-lence of diabetes mellitus and diabetes-related complications such as retinopathy and neph-ropathy observed in minorities, we hypothe-sized that Mexican Americans and blacks with diabetes would have substantially more lower-extremity amputations than their non-Hispanic white counterparts. Since no data have been published on the incidence of diabetes-related amputations in Mexican Americans and little specific information regarding blacks at the time the estimates for Healthy People 2000 were developed, it would not have been possi-ble to consider the excess risk of amputations in this segment of the population. As a result, public health planners may have underesti-mated the impact of diabetes-related amputa-tions in south Texas and in other states with large minority populations. The purpose of this study is to identify racial/ethnic differ-ences in the incidence of lower-extremit