Access to quality, consistent care is imperative for patients with diabetes to maintain their health. Having an ongoing care plan is the best way for patients to avoid complications — one of the most common being diabetic foot ulcers, which can lead to the partial or whole amputation of the foot.
The Centers for Disease Control and Prevention’s most recent data on the diabetes-related amputations, from 2016, shows that there were 4.9 lower-extremity amputations per 1,000 diabetic adults in the U.S. Among diabetic people who have had a lower-extremity amputation, more than half may end up having an amputation of the opposite extremity within five years, according to the agency.
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The American Diabetes Association announced an initiative last week aimed at tackling this issue. The nonprofit launched the Amputation Prevention Alliance — a three-year effort to decrease the number of diabetes-related amputations in the country — along with five partner organizations.
Those partners include diabetic foot care provider Podimetrics, wound care company Advanced Oxygen Therapy and membership-based medical society Critical Limb Ischemia Global Society, as well as medical device companies Abbott and Cardiovascular Systems.
The majority of diabetes-related amputations are preventable, according to Jon Bloom, Podimetrics’ CEO and co-founder.
As diabetes advances within a patient, they may experience nerve damage called diabetic neuropathy, in which damaged tissue struggles to heal. Peripheral neuropathy — nerve damage that leads to sores on the feet and legs first — is the most common form of diabetic neuropathy, according to Bloom. The hands and arms can also be affected later, he said.
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Patients at risk for diabetic foot ulcers might not even feel a sore forming on their foot. When this is the case, the sore continues to get worse and does not heal well due to increased blood sugar levels, Bloom pointed out. These sores often advance to require diabetic amputation — an issue Bloom said is “simply not talked about enough.”
To combat the public health issue of preventable diabetes-related amputations, the alliance will prioritize patient education about the signs and symptoms associated with diabetic foot ulcers and diabetic neuropathy. It will also work with providers to ensure their patients with complex diabetes have regular check-ups, including appointments with a podiatrist that are focused primarily on foot health, Bloom said.
The Amputation Prevention Alliance plans to advocate for needed policy changes, one example of important legislation being the The Amputation Reduction and Compassion Act. The bill, which was introduced in Congress last year, would provide coverage of peripheral artery disease (PAD) screening for at-risk beneficiaries under the Medicare and Medicaid programs without cost-sharing requirements.
“By expanding coverage for PAD screening, the bill would help prevent vulnerable individuals from developing serious complications from PAD, which can lead to amputation,” Bloom said. “The ARC Act would also prohibit the use of amputation without the completion of testing to determine if alternative options could be utilized to benefit the patient and establish a PAD education program.”
The alliance has also formed a clinical advisory working group to produce recommendations mapping to policy change, clinician education programs and improved patient engagement, according to Bloom.
The initiative will focus on reaching providers and patients in communities facing disproportionately high rates of amputations and amputated-related mortality, such as the Black and Latino communities. Black people in the U.S. face amputation rates up to four times higher than White Americans, and Latino people are 50% more likely to have an amputation, according to the announcement.
To Bloom, the alliance’s success will be determined by one metric: whether or not it can reduce the more than 154,000 amputations that occur every year in the U.S.
Photo: gustavofrazao, Getty Images
