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Diabetic Amputations May Be Rising in the United States

Mary Caffrey
The report in Diabetes Care, the official journal of the American Diabetes Association, comes after reports of rising rates of diabetes and obesity among young adults and soaring insulin costs, which may mean diabetes is not being effectively treated.
Lower-limb amputations may be rising in the United States after decades of decline, according to data published in Diabetes Care, the official journal of the American Diabetes Association.

The study, which evaluated hospitalization rates for nontraumatic lower extremity amputation in the years 2000 to 2015 using data from the National Health Interview Survey, evaluated estimates for populations with and without diabetes.

Poorly controlled blood sugar that occurs in diabetes can limit blood flow to the lower legs and toes, causing nerve damage that people with the disease may not sense until problems have already developed. People with advanced diabetes may develop wounds or sores that do not heal and eventually result in loss of the damaged toe or portion of the foot or leg.

Cardiologist Foluso A. Fakorede, MD, who practices in the Mississippi Delta, recently wrote about the dangers of untreated peripheral artery disease and amputation risk for The American Journal of Managed Care®.

“Each year, approximately 200,000 non-traumatic amputations occur. African Americans are 4 times more likely to experience diabetes-related amputation than whites. In the United States, every 17 seconds someone is diagnosed with diabetes, and everyday 230 Americans with diabetes will suffer an amputation,” Fakorede wrote. “Throughout the world, it is estimated that every 30 seconds a leg is amputated. And 85% of these amputations were the result of a diabetic foot ulcer.”

After years of decline, the rate of amputations increased by 50% between 2009 and 2015 to 4.6 for every 1000 adults, the authors found. They noted that the increase was especially sharp among young adults (age 18 to 44 years) and those in middle age (45 to 64 years). These groups are more likely to be uninsured than people age 65 or older, who qualify for Medicare.

The report coincides with reports that claims data show more young people are being diagnosed with diabetes and obesity, as well as efforts by advocacy groups and Congress to address soaring costs of insulin over the past decade. Doctors and patients alike say patients are rationing insulin and skipping doses, putting their long-term health at risk, and the American Diabetes Association has made addressing insulin costs a priority.

Researchers found that for every 1000 adults with diabetes younger than 45, the number of amputations fell from 2.9 to 2.1 from 2000 to 2009, then soared to 4.2 in 2015.

This week, FDA Commissioner Scott Gottlieb, MD, warned that insulin would be reclassified from a drug to a biologic to increase competition and drive down prices.

Reference

Geiss LS, Li Y, Hora I, Albright A, Rolka D, Gregg EW. Resurgence of diabetes-related nontraumatic lower extremity amputation in the young and middle-aged adult US population [published online November 8, 2018]. Diabetes Care. https://doi.org/10.2337/dc18-1380.

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