COMMENTARY

We Have an Amputation Epidemic

Robert A. Gabbay, MD, PhD; Foluso Fakorede, MD

Disclosures

November 29, 2022

Every three minutes in America, a person loses all or part of a limb due to their diabetes.

Every. Three. Minutes.

Robert A. Gabbay, MD, PhD

Five-year mortality numbers for individuals undergoing a diabetes-related amputation rival those of many forms of cancer. Tragically, your odds of suffering from limb loss can come down to the color of your skin, your gender, your educational level, where you live, or how much money you make. This is the definition of a health inequity. And it's a crisis costing us thousands of lives every year.

Black Americans are four times more likely to suffer an amputation than are White Americans. Latinx communities face amputation rates two times higher than those of White persons. Indigenous Americans are also at increased risk for an amputation. These same communities face disproportionately high rates of diabetes and are more likely to have serious complications like strokes, heart attacks, and death.

Foluso Fakorede, MD

The reality is that living with diabetes puts you at increased risk of suffering from limb loss. In fact, diabetes can lead to circulatory problems such as diabetic foot ulcers, peripheral artery disease (PAD), neuropathy, and other conditions, such as critical limb ischemia, that greatly increase your risk for limb loss. But this doesn't have to be the case. As many as 85% of all diabetes-related amputations are preventable through earlier intervention, diagnostics, and care.

The fact is that, for many, an amputation is a death sentence. This also doesn't have to be the case. Early detection and intervention can prevent amputations from occurring. PAD screenings, foot checks, access to services from a podiatrist or a vascular specialist, diagnostics, revascularizations, and access to quality care can significantly reduce amputation risk in people living with diabetes. Unfortunately, these services are often inaccessible to patients. Making matters worse, patients are often unequipped with the necessary information to make informed choices about their healthcare. This leads to the roughly 154,000 diabetes-related amputations that take place every year in the United States.

Solving this problem will not be easy. It will require structural changes to the way our healthcare system treats people with diabetes. It will require, in many cases, re-educating the healthcare workforce on new treatments and preventive strategies. It will require empowering patients with the knowledge and tools they need to advocate for their healthcare. It will require policy changes to fundamentally improve care for people with diabetes.

It is an urgent call and one that we're proud that the American Diabetes Association (ADA) is prepared to answer.

November marks American Diabetes Month. The theme of this year's American Diabetes Month is "diabetes hits different." Fortunately, recent medical advances have decreased rates of some diabetes-related complications. However, the same cannot be said for rates of diabetes-related amputations, which have increased 75% in the past 10 years.

In honor of this, the ADA is launching a campaign to prevent the tens of thousands of unnecessary amputations that take place among people with diabetes every year. In doing so, the ADA is launching the Amputation Prevention Alliance whose purpose is to increase awareness of tools and resources to prevent amputations. This newly formed alliance seeks to change the status quo in how we treat people with diabetes-related foot complications. In short, the ADA seeks to change the care paradigm from one where we amputate first and ask questions later to one where we amputate as a last-resort care option.

Doing so will not be easy. There are fundamental biases inherent to our healthcare system that result in differentiated care for these patients. Success will require educating and empowering the more than 37 million Americans living with diabetes about risks for amputation, when to seek care, and how and when to seek second opinions. It will require educating the healthcare workforce about opportunities to prevent limb loss and how healthcare providers can partner with one another on patient care. It will require federal policy changes to ensure adequate reimbursement for screenings and medical interventions to prevent amputations.

Most important, it will require systemic change in how and when we diagnose these patients and reaching them earlier in their care journey. In doing so, we can help these patients. The time for action is now. The ADA is proud to lead this incredibly important initiative that will save limbs and save lives.

Because feet matter and lives matter.

Dr Robert Gabbay is the chief scientific and medical officer for the American Diabetes Association and leads the ADA's efforts to drive discovery within the world of diabetes research, care, and prevention. Dr Foluso Fakorede is an expert at catheter-based procedural focus in coronary atherosclerosis disease and peripheral atherosclerosis disease.

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