Diabetic foot ulceration and diabetes-related lower-limb amputation in the Caribbean: burden, outcomes and care pathways – a scoping review

Abstract Background Diabetic foot ulceration and diabetes-related lower-limb amputation are late complications of diabetes, the frequency of which depends on early detection, referral and treatment. Evidence from the Caribbean is scattered across single countries and institutions and has not been mapped. We aimed to map evidence published from 2016 onward on the burden, outcomes and care pathways of diabetic foot ulceration and amputation in the Caribbean and to identify gaps relevant to surveillance and health services. Methods We conducted a scoping review following the PRISMA-ScR guidelines. No protocol was registered. PubMed was searched with 7 query blocks combining diabetic foot, amputation and Caribbean place names, followed by a supplementary search seeded from the included studies. Records from 2016 onward were screened by title and abstract, and only studies with accessible full texts were included. The data were extracted into a 44-field worksheet and synthesized descriptively and thematically. Results The search identified 150 records (94 unique). Twenty-one studies passed the abstract screening, 15 had accessible full texts, and the supplementary search added 2 studies, resulting in 17 included studies (7 core, 10 partial). Barbados and Trinidad and Tobago each contributed 5 studies. In a Barbados diabetes programme, 14.7% (33/225) of patients had a foot ulcer in 2019. The amputation incidence in Martinique was 48.9 per 100,000 inhabitants in 2018. At one Trinidad institution, the number of major amputations increased from 66 to 152 per year between 2010 and 2016, the 2-year mortality rate was 34%, and 14.5% of patients acquired a prosthesis. A 25-country survey revealed diabetic foot guidelines in 9 countries and no functional multidisciplinary foot units. The authors most often reported sample size and representativeness (10/14 studies) and selection or self-report bias (9/14) as limitations. Conclusions Caribbean evidence on diabetic foot ulceration and amputation is limited, concentrated in 2 countries, and largely single-center or cross-sectional. We found no population-based ulcer incidence studies, national registries, or evaluations of prevention or multidisciplinary programs. Priorities for the region include a shared definition and registry for ulcers and amputations; population-based estimates; and evaluations of screening, education and organized foot care services.