Poorly controlled diabetes can lead to amputations of toes, feet or legs, though it isn’t inevitable. Your race and where you live might play a big part in whether amputation is your fate if you are diagnosed with the blood sugar disorder, new research suggests. The study found that Black people are less likely to have a minor amputation, but more likely to have a major amputation than white people.
“If you go to the experts that are there to help you live a [healthy] lifestyle with diabetes, this does not have to happen to you,” Dr. David Alper, a member of the American Diabetes Association’s (ADA) Northeast Leadership Board and trustee of the American Podiatric Medical Association says.
Researchers recently reported in the ADA journal Diabetes Care that minor lower extremity amputations rose among American adults with diabetes between 2009 and 2017, while major amputations held steady.
Major amputations rose for whites, Midwesterners and those in rural areas, the study found.
The increase in minor amputations was most pronounced among Asian Americans and Pacific Islanders, as well as those who were Native American, rural residents and those living in the West.
Major amputations are those above the foot, or below or above the knee. Amputations of the foot or toe are considered minor. Poor diabetes control can lead to serious health issues, including neuropathy, which is reduced feeling in the extremities, and potentially to amputation.
“The good news is the major-to-minor amputation ratio is dropping, which means there are fewer major amputations being conducted and more minor amputations,” study author Marvellous Akinlotan, a research assistant professor at Texas A&M University College of Nursing in Bryan, Texas says. “Even though an amputation of any kind can be devastating, that ratio is dropping and that shows that diabetes management efforts are paying off.”
READ: Diabetes: What to Eat When You’re Sick
That includes “the comprehensive foot examinations that are now part of the diabetes management programs” and earlier detection of infections Akinlotan shares.
Patients in the South were more likely to have a major amputation than those living in
the Northeast or urban areas, the study found.
The increased odds for amputation for people in rural areas is consistent with other studies that have reported poorer health outcomes for residents of rural areas. Researchers says this could be due to less access to specialized diabetes-related medical care, fewer health care providers, lower rates of health insurance coverage, lower-income and limited public transit.
“If an individual doesn’t have health insurance, they’re less likely to get a regular check, and if the blood sugar is already out of control, the individual may not be aware or able to get care in a timely manner,” Akinlotan says.
Potential solutions include comprehensive ongoing care of patients with diabetes and a better understanding of the cultural factors that are at play, particularly among ethnic groups and Southerners, according to Akinlotan.
These findings could help policymakers and health care providers offer more targeted interventions, including telehealth and web-based diabetes care and education.
The results are not surprising, Alper says. Diabetes experts have been aware of the increases in certain types of amputation and that they’re happening in an uneven way, depending on race, economic situation and location.
The problem also has escalated during the COVID-19 pandemic as some people have been afraid to go to doctor appointments.
Individuals who have a family history of uncontrolled diabetes or diabetes-related amputation are more likely to experience that themselves. The reality is that health care is less available in poorer, more rural areas, which means patients are not getting early intervention or good quality diabetes control. The wide availability of sugary drinks and the high cost of a diabetes-controlling diet add to
the challenges, Alper adds.
READ: Diet Key to Better Health in People With Diabetes
A key to changing this situation is education and not just through medical professionals in a doctor’s office but through a nurse educator standing up in church, for example, and talking about diabetes. Employers can also offer education.
“The truth is, especially in 2021, people are getting their medical education from ancillary providers, from nurse practitioners, physician’s assistants and diabetic nurse educators,” Alper says. “And we need to educate these people more and get them out into the public more because these are the ones that people are seeing and getting their care from.”
READ: Diabetes Management: Why Black People Need a Trustworthy Doctor
In order to avoid amputations, you must manage your diabetes well. You should always consult with your doctor for the best solutions. In the meantime you can also try the following:
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