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Diabetes-Linked Amputations Declining, Study Finds

Although disease rates are rising, orthopedic treatments have improved, experts say


Amputations among people with diabetes happen because they do not produce any or enough of the hormone insulin to properly convert food into energy. The result is too much sugar in the blood, which in turn causes nerve damage that can reduce feeling in the feet, leading to the development of sores or ulcers.

If these ulcers become severely infected, life-saving amputation may be needed. Some people lose one or two toes or the edge of the foot, but others require more drastic measures, such as above-the-knee amputation.

Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, said the United States lags behind other countries in terms of diabetes foot care.

"I have traveled around South America and Europe to see how they manage patients with diabetic feet," Zonszein said. "They seem to be doing much better than we are. Although it doesn't happen everywhere in those countries, experts there generally treat patients with a diabetic foot much more aggressively and are much more up-to-date than we are here."

In the United States, many insurance companies won't cover prevention of diabetic foot problems, Zonszein explained. There is evidence that contact casting can help, but since many payers won't reimburse the costs for the procedure, few doctors use it, he said.

"This is a typical case where spending a little bit of money would prevent a lot of expenses later for Medicare -- in transportation, wheelchairs, and disability for the patients," Zonszein said.

Teaching proper foot care is also an important aspect of preventing ulcers from occurring, but this also falls under the realm of prevention, which isn't paid for, Zonszein said. Instead, "[payers] pay for complications and amputations," he noted.

With proper treatment, only 30 percent of ulcers recur, said Phisitkul. Doctors can still reduce this another 14 percent with better treatment, he added.

While surgical interventions and contact casting help reduce foot ulcers and subsequent higher level amputations, patients must play a role in prevention as well, said Phisitkul.

"Patients with diabetes have to do their best to control their blood sugar. They need to seek care from their primary care doctor, get treatment, and discuss potential surgeries [like tendon release] to help improve their feet," Phisitkul said.

Diabetes is a silent disease but it eats away at the body, Phisitkul added. "Patients need to try to fight against diabetes sooner than later, rather than waiting for complications to begin," he said.

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