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Understanding Diabetes Risks Can Save Your Limbs
December 03, 2019

Understanding Diabetes Risks Can Save Your Limbs

Gerald Niedzwiecki, MD, is a board-certified and fellowship trained interventional radiologist at Advanced Imaging and Interventional Institute, an interventional outpatient center in Tampa Bay, Florida. He is also a member of the CardioVascular Coalition.
Diabetes is a well-known term; however, it’s safe to bet most people don’t fully understand the disease, its risks, and its serious health implications.  In recognition of American Diabetes Month, it is important to acknowledge the various health risks associated with diabetes, including peripheral artery disease (PAD), which can lead to devastating health outcomes.

Across the United States, diabetes poses a major health challenge for all age groups, races, and both men and women. According to the latest statistics, more than 30 million Americans—nearly 10% of the US population—have been diagnosed with diabetes. Meanwhile, an additional 84.1 million Americans have prediabetes. As the seventh leading cause of death in the United States,  diabetes is a complex, chronic health condition that can also lead to many painful and dangerous complications.

One of the little-understood complications of diabetes involves damage to a person’s arteries. Over time, blockages can build up and restrict the blood flow in a patient’s limbs and lower extremities. This is called peripheral artery disease, or PAD. If left untreated, PAD causes leg pain and can often lead to multiple complications including gangrene, diabetic foot ulcers, and, eventually, amputation.

While not all patients with PAD have diabetes, the disease is a significant risk factor. Nationwide, 8 to 12 million Americans have been diagnosed with PAD, including 1 in 20 Americans over the age of 50. And with as many as 25% of American seniors living with diabetes, the risks of developing PAD are significant. 

This is especially true for communities of color, who disproportionately suffer from both diseases.  African Americans are 80 percent more likely than whites to be diagnosed with diabetes and twice as likely to die from it. Data show African American patients with diabetes are more than 3 times more likely to have their limbs surgically removed than their white counterparts. Other minority groups face similar odds: Hispanics are 75% more likely to develop PAD than whites, while, in the western United States, Native Americans are twice as likely to suffer from the disease. 

While it is important for at-risk populations to understand PAD, it is also important for diabetics to be screened for PAD, especially if they are symptomatic. If properly diagnosed, PAD is a manageable disease.  Left untreated, limb amputation is a stark reality.

With an estimated 200,000 nontraumatic limb amputations in the United States every year, early PAD detection and treatment are vital to saving limbs in the future. Although early screening has been shown to reduce the likelihood of a PAD-related amputation by 90%, it is greatly underutilized since only 1 in 8 patients with PAD are identified by doctors and treated.

One reason for this is that the US Preventative Services Task Force (USPSTF), the agency responsible for creating guidelines for diagnosing and treating common diseases, recommends against PAD screening, calling the evidence of its benefits “insufficient.” This recommendation is an incredible disservice to at-risk patients, for whom screening practices should be encouraged.

The USPSTF guidelines apply to the general public, where they should instead apply to the most at-risk populations, including racial minorities and diabetics. If that were the case, as it is with the  American College of Cardiology and American Heart Association joint practice guidelines, more Americans vulnerable for PAD would receive clinically appropriate screening and intervention.

While I urge the USPSTF to recommend screening for at-risk populations, people with diabetes cannot afford to wait.  When lives and limbs are at stake, it is absolutely critical for patients to talk with their doctors about getting tested for PAD. The test is quick, painless, and non-invasive.

As I reflect on the severity of the diabetes and PAD epidemics—and how to overcome them—I share this advice in hopes that more people will understand their risks and seek the care they need. 

About the Author

Gerald Niedzwiecki, MD, is a board-certified and fellowship trained interventional radiologist at Advanced Imaging and Interventional Institute, an interventional outpatient center in Tampa Bay, Florida.  He is also a member of the CardioVascular Coalition.

 
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