November is Diabetes Awareness Month

The Diabetes PAD Connection

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Diabetic Foot Care:  Avoiding Diabetic Amputations

 

November is Diabetes Awareness Month, and knowledge of Diabetes, its risks and symptoms are very important to everyone who may be susceptible to this disease or have loved ones who are. Just as important is awareness of how to recognize and what to do about the most serious effects of Diabetes, particularly those who risk lower limb amputation from Peripheral Artery Disease (PAD).

 

What to Know About Diabetes and PAD

Diabetes is common, but it gets more common to those over 65- one in four people in that age group will develop the disease[1]. Add to that people with histories of smoking, obesity, or diabetes in the family, and overall more than 34 million Americans have diabetes, according to the Centers for Disease Control.[2] What’s more, one in five diabetes sufferers don’t even know they have it[3].

 

Diabetic foot infections cause the most hospitalizations; 20 percent of all hospitalizations are due to diabetic foot infections[4], including ulcers. One reason they go untreated too long is that due to PAD – which is commonly attributed to diabetes (20percent of cases[5]), diabetics often do not notice an injury or ulcer to their lower limb until well after it has happened.

 

Lower limb amputation is a serious risk for those with Diabetes. Currently, as many as 25 percent of the diabetic population have a chance of losing some part of their foot or leg due to PAD. To put that number into sharper focus, someone undergoes an amputation every 20 seconds[6] – an event that is becoming more frequent. Amputation is not merely the loss of a toe, leg, or a foot; it is life-changing, with at least a third  of amputees never walking again, and with that comes the risk of nursing home placement and increased mortality rates[7]. The financial burden is heavy as well; the estimated lifetime medical costs for an amputee can grow to more than $500,000[8].

 

Awareness and treatment lower the rate of amputations; Being aware of symptoms and having regular checkups with primary doctors and podiatrists helps spot dangers early and prevent symptoms from progressing to the point of amputation. In addition, Interventional Radiology (IR), a minimally invasive, image-guided procedure is becoming a more common way to treat vascular disease. Vascular procedures like IR are already reducing amputation rates due to PAD by 20 percent[9], and these procedures are becoming more common as awareness grows.  Concerned about your risk?  Take this easy interactive quiz.

 

Diabetes Awareness Month is about more than awareness of the disease itself, but also of how to treat its most severe effects, and as a result saving limbs and the hope for an untold number of patients to continue their normal lives.

 

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Coordination of Care for Diabetes Patients: Reducing the Risk of Amputation
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[1] Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2011. Atlanta, Georgia, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011

[2] Centers for Disease Control, 2020

[3] Centers for Disease Control, 2020

[4] Frykberg RG, Wittmayer B, Zgonis T. Surgical management of diabetic foot infections and osteomyelitis. Clin Podiatr Med Surg. 2007;24:469–82. [PubMed] [Google Scholar]

[5] Wu, S., Driver, V., Wrobel J., and Armstrong D., Foot Ulcers in the Diabetic Patient, Prevention and Treatment. Vascular Health Risk Management. 2007 Feb; 3(1): 65-76

[6] A systematic review and meta-analysis of patient education in preventing and reducing the incidence or recurrence of adult diabetes foot ulcers (DFU), NIH, 2018

[7] Frykberg RG, Arora S, Pomposelli FB Jr, LoGerfo F. Functional outcome in the elderly following lower extremity amputation. J Foot Ankle Surg. 1998;37(3):181-5; discussion 261.

[8] Blough DK, Hubbard S, McFarland LV, Reiber GE, Smith DG, Gambel JM. “Prosthetic Cost Projections

for Servicemembers with Major Limb Loss From Vietnam and OIF/OEF.” Journal of Rehabilitation

Research and Development 2010;47(4):387-402

[9] Mentias A, Qazi A, McCoy K, et al. Trends in Hospitalization, Management, and Clinical Outcomes Among Veterans with Critical Limb Ischemia. Circ Cardiovasc Interv 2020 Feb 13