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More than 100,000 Americans with diabetes have limbs amputated each year. This is a crisis

People with diabetes who have foot amputations live at the other end of the diabetes periscope. Their smiling faces are not found in the ADA annual reports. They are not featured in the endless TV commercials promoting the latest glucose-lowering drug. Their struggles are interwoven with our other challenges of poverty, race and inadequate healthcare. Amputees in the US are close to invisible.

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 How Diabetic Foot Ulcers Lead to Amputations

Can diabetic amputations be prevented? Absolutely. In fact, they are highly preventable. The best way to prevent an amputation is to prevent the diabetic foot ulcer from forming. There are steps that can be done at home, such as performing regular foot exams, engaging in daily movement to keep blood flowing, and wearing proper footwear. Additionally, diabetic foot ulcers can be prevented by using thermometry. Thermometry will measure the temperature of the foot, recognizing changes that signal inflammation. When intervention occurs earlier on, most diabetic foot ulcers can be prevented — with the hope that amputation is not necessary.

 The Diabetes Complication Hiding in Plain Sight

Diabetic amputation is a huge problem, yet it’s not commonly talked about. These patients can be helped. With proper foot monitoring, diabetic foot ulcers can be prevented with simple measures, like offloading. To save a limb is to give someone their life back, and we can’t forget these patients. To start, awareness is important.

Articles of Interest

Amputation in Diabetic Patients

Foot ulcers and their complications are an important cause of morbidity and mortality in diabetes. The present study examines the amputation risk criterion and the long term outcome in terms of amputations and mortality in patients with diabetic foot.

Amputations due to diabetes can be prevented

Taking a minute or two every day to inspect your feet and observing a few simple rules can make the difference in sparing diabetes patients from a preventable outcome of the disease – a foot amputation. “Of all diabetes-related complications, a serious foot ulcer and subsequent amputation might be the most preventable with proper care and vigilance in checking the feet at least once a day for small cuts and other abrasions,” says Dr. Kevin Lam, a member of the American College of Foot and Ankle Surgeons (ACFAS). “Even those with good control of their blood sugar can experience foot ulcers, especially if neuropathy, a frequent diabetes complication, has caused decreased feeling on the bottom of their feet.”

Diabetes & Foot Amputation: The Shocking Truth About How Many Are Preventable

Understanding the connection between diabetes and foot amputation empowers you to take control of your health. While the risks are serious, they are manageable. By inspecting your feet daily, wearing proper footwear, and controlling your blood sugar, you can stay active and healthy.

Diabetes and landmine related amputations: a call to arms to save limbs

The effects of landmine-related morbidity have long been the subject of intense attention by the media, governments and non-governmental organizations alike. While much remains to be done in this area, it can be argued that major advances have been made (4–6). At the other end of the spectrum, the epidemic of diabetes-related limb amputations continues its inexorable rise; despite a surprisingly high 5-year mortality associated with this preventable scourge, the lay public and press seem largely unaware and policy-makers have failed to appropriately respond. In many ways, diabetes-related amputations are strikingly similar to those associated with landmines.

Diabetes Is Fueling an Amputation Crisis for Men in San Antonio

A lethal combination of genetics, poor access to health care and diets high in processed foods is fueling a diabetes crisis in Latino communities, especially in Texas.

Diabetic Amputations

Aim to preserve foot if possible...

Diabetic people 'having unnecessary amputations'

Parliamentary group and charity Diabetes UK call attention to wide disparity in treatment of condition across UK.

Divorced men at highest amputation risk among diabetics, study finds

Researchers speculate this may be due to change in self-care, food habits and social isolation.

Facing my fear: losing most of my right foot to diabetes

I’ve been a diabetic since 2010; for the most part, I viewed complications from the disease as a late-night punchline, albeit rarely a funny one. All of the ominous and scary crap – kidney failure, blindness, systemic shutdown of the body, loss of limbs – that my physicians warned me about were off in the distance of some murky fantasy-future. I was in my early thirties, overweight but still invincible. I’d convinced myself, mostly out of a fear-based denial, that none of this could or would happen to me.

Geographic and Ethnic Inequalities in Diabetes-Related Amputations

Individuals with diabetes mellitus are at increasing risk for major lower-extremity amputations (LEAs). Poor quality of life and remarkable disabilities are associated with LEAs, determining a high economic burden for the healthcare systems. Reducing LEAs is therefore a primary marker of quality of care of the diabetic foot.

Many diabetic foot amputations are preventable

Limb-salvage experts say many of the 80,000-plus amputations of toes, feet and lower legs that diabetics undergo each year are preventable if only patients got the right care for their feet. Yet they're frustrated that so few do until they're already on what's called the stairway to amputation, suffering escalating foot problems because of a combination of ignorance — among patients and doctors — and payment hassles.

Preventing a million diabetic foot amputations

Every 20 seconds someone, somewhere on the planet, loses a foot due to diabetes. Foot ulcers are the starting point of more than 80% of these amputations, and they could be prevented.

Recovering From a Diabetes-Related Amputation

Managing diabetes and taking care of your feet is extremely important to prevent a lower-limb amputation (LLA). But for some people living with diabetes, an LLA may be the only safe treatment for a severe infection. With time and practice, you can adjust and live a healthy lifestyle after an LLA.

Reducing Amputations in People with Diabetes (RAPID): Evaluation of a New Care Pathway

The RAPID project was made up of two phases: firstly, to evaluate the technical feasibility of a new integrated care pathway using innovative technology, and secondly, to establish process enhancement of the pathway to justify a larger-scale study. Omni-HubTM enabled a face-to-face consultation by the community podiatrist to be enhanced by virtual consultation with members of the multidisciplinary foot team, including specialist diabetes podiatrists and a diabetes consultant.

Risk factors affecting amputation in diabetic foot

Osteomyelitis, peripheral artery disease, chronic kidney disease, ulcer size, and forefoot ulcer location were risk factors for amputation in diabetic foot patients.

The Diabetic Amputee

Diabetics are 15 times more likely to undergo a LEA than non-diabetics. Furthermore, diabetics who have undergone a LEA have a 55% greater risk of death than non-diabetics. The risk of reamputation is greater in diabetics with the rate of major amputation of the contralateral limb is 11.6% at 1 year and 53.3% at 5 years. With this in mind, protection of the diabetic amputee’s contralateral limb has more meaning. One study found that in diabetic patients have “an identifiable and potentially pivotal event, in most cases an episode involving minor trauma that caused cutaneous injury, preceded 69-80% of amputations".

Treatment of the diabetic foot – to amputate or not?

Diabetic foot infections are a frequent clinical problem. About 50% of patients with diabetic foot infections who have foot amputations die within five years. Properly managed most can be cured, but many patients needlessly undergo amputations because of improper diagnostic and therapeutic approaches.

Why Does Diabetes Increase the Risk of Limb Amputation?

The path from foot ulcers to infections shows how serious diabetes is for limb amputation. How does diabetes cause this? Poor blood flow, nerve damage, and a weakened immune system can lead to this negative result. Understanding the underlying reason for this link can help us proactively address amputation risk factors.

Resources

Amputation Prevention Alliance

Amputations are on the rise in the United States—160,000 people with diabetes undergo amputation each year. And 80% of non-traumatic lower limb amputations happen due to diabetes complications. An individual who has had an amputation has a worse chance of five-year survival than someone with coronary artery disease, breast cancer, and colorectal cancer. Amputations in the United States are also substantially more prevalent among people of color. Quite simply, whether or not you have a limb amputated can come down to the color of your skin, how much money you make, and where you live.