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 partial or total leg amputation.
The Centers for Disease Control and PreventionThe most recent data on diabetes-related amputations, from 2016, showed that there were 4.9 lower limb amputations per 1,000 adults with diabetes in the US. Among people with diabetes who have had a lower limb amputation, more than half may end up with an amputation of the opposite limb within five years, according to the agency.
The American Diabetes Association last week announced an initiative aimed at tackling this problem. The non-profit organization launched The Amputation Prevention Alliance — a three-year effort to reduce the number of diabetes-related amputations nationwide — along with five partner organizations.
These partners include a diabetic foot care provider Podimetrywound care company Advanced oxygen therapy and a membership-based medical society Critical limb ischemia Global Societyas well as medical device companies Abbott and Cardiovascular systems.
The majority of diabetes-related amputations are preventable, according to John Bloom, CEO and co-founder of Podimetrics.
As a patient’s diabetes progresses, they may develop nerve damage called diabetic neuropathy, in which the damaged tissue struggles to heal. Peripheral neuropathy — nerve damage that causes sores first on the feet and legs — is the most common form of diabetic neuropathy, according to Bloom. The arms and hands can also be affected later, he said.
Patients at risk of diabetic foot ulcers may not even feel the ulcer forming on their feet. When that’s the case, the wound continues to get worse and doesn’t heal well because of the elevated blood sugar levels, Bloom said. These wounds often progress and require amputation in diabetes, a problem Bloom said “is just not talked about enough.”
To combat the public health problem 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 also will work with providers to ensure their patients with complicated diabetes have regular checkups, including podiatrist appointments, that are primarily focused on foot health, Bloom said.
The Alliance to Prevent Amputation plans to advocate for needed policy changes, with one example of important legislation being 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 PAD screening coverage, the bill will help prevent vulnerable individuals from developing serious complications of PAD that could lead to amputation,” Blum said. “The ARC Act would also prohibit the use of amputation without completing testing to determine if alternative options can be used to benefit the patient and establish a PAD education program.”
The alliance has also formed a clinical consultation task force to develop recommendations aligned to policy change, education programs for clinicians 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 amputation-related mortality, such as black and Latino communities. Black people in the U.S. face amputation rates up to four times higher than white Americans, and Hispanics are 50 percent more likely to have an amputation, according to the release.
According 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 each year in the U.S.
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