The Diabetes Complication Hiding in Plain Sight: Diabetic Amputation
Diabetes is common in the U.S. 34 million people have diabetes, including adults and children. Diabetes is an epidemic, and turning that tidal wave isn’t easy. The majority of diabetes prevention solutions focus on intervention when the disease is in its nascent stages, what about the elephant in the room? We’re talking about diabetic amputation.
Every four minutes, a limb is amputated to diabetes. There are over 150,000 non-traumatic amputations per year. Diabetic amputation is a huge problem, yet no one is talking about it. And it’s not because they don’t care. It’s because they don’t know that much about it.
Diabetic amputation is commonly the result of diabetic foot ulcers, or DFUs. As diabetes advances, nerve damage called diabetic neuropathy can occur and damaged tissue struggles to heal.
Peripheral neuropathy is the most common form of diabetic neuropathy, where the feet and legs are affected first. Later, the hands and arms can also be affected. This makes it especially hard to detect any changes in temperature or to feel pain.
This can be particularly difficult for those at risk for diabetic foot ulcers or complications. They might not even feel a sore forming on their foot. All the while, the sore is getting worse and not healing well due to increased blood sugar levels. Eventually, these sores can advance and require diabetic amputation.
Amputation is highly traumatic — even though it’s preventable.
The toll of diabetic amputation is actually a cycle. For patients who get diabetic amputations, 19% will have another amputation within one year of the first. Within five years of the first amputation, a whopping 37% will have another one. These numbers are staggering.
On top of that, the mortality rate for amputation is particularly devastating. According to the Center for Medicare and Medicaid Services, 62% of patients who have a diabetic amputation die within five years — twice the five-year mortality rate for all reported types of cancer combined. And the rate of lower extremity amputation just keeps accelerating, more than doubling between 2019 and 2020.
And these stats don’t account for the tremendous weight on patients’ mental health. Having an amputation is life-altering, reducing mobility, and changing lifestyles. It can trigger depression, anxiety, and post-traumatic stress responses. Alongside mental health concerns, there is also an association between diabetic foot ulcers (the precursor to amputation) and severe health conditions. In fact, during a diabetic foot ulcer episodes-of-care, individuals are 30 times more likely to have a lower limb amputation, eight times more likely to be hospitalized for peripheral vascular disorders, and about two times more likely to be hospitalized for renal failure, congestive heart failure (CHF), pulmonary edema, chronic obstructive pulmonary disease (COPD), or a heart attack.
These associations only signal the fact that patients with amputations are likely to be more medically complex. This means everything is harder for them, including any treatment for other health conditions. It also means the toll is exponentially greater, leading to debilitating and costly medical interventions.
Patients with amputations also reflect high rates of health inequity. Black Americans are three times more likely to suffer a diabetic amputation. And those living in the poorest communities in the U.S. are 39% more likely to have a high-level amputation.
These figures illustrate that there is a lot of work and research to do. It’s critical that we learn as much as we can about this patient population to better serve their needs in an accessible way. If the cycle continues, and more amputations occur, this is only compounded. The patient’s quality of life can take a huge hit. But this can all be prevented if we intervene earlier on, before the diabetic foot ulcers turn the patient into a candidate for amputation.
Diabetic amputation is a huge problem, yet it’s not commonly talked about. These patients can be helped. With proper foot monitoring, diabetic foot ulcers can be prevented with simple measures, like offloading. To save a limb is to give someone their life back, and we can’t forget these patients. To start, awareness is important. Let’s learn more about this diabetes complication so that we can better understand how to serve our most vulnerable patient populations.