A vascular surgeon suggests that patients with diabetes may have so many issues to cover during a 15-minute appointment that they don't mention occasional leg pain.
Diabetes and peripheral artery disease (PAD) hit harder in the African American population, putting them at higher risk of amputations that could be prevented, according to the Society for Vascular Surgery.
African Americans are twice as likely as whites to have PAD, and 1 in 4 older African Americans has diabetes. In a California claims study recently published in the Journal of Vascular Surgery, African Americans who had both diabetes and PAD had the highest rates of preventable amputations.
The study examined patterns in the data from more than 219,547 patients with lower extremity ulcers; of these, 131,731 were associated with diabetes and 36,193 had PAD; 51,623 were associated with both PAD and diabetes.
Both diabetes and PAD create conditions that can lead to amputation. Diabetes causes neuropathy, causing wounds to heal slowly and making it hard to feel pain in the feet; a small sore might seem inconsequential and develop into a serious foot ulcer. PAD, meanwhile, occurs when layers of plaque clog the blood vessels and restrict blood flow. Infections can result, which can lead to conditions like gangrene and, later, amputation.
The data in the California study revealed that men were more adversely affected than women by high amputation rates. “Studies show that African Americans, especially men, may not go to the doctor as often,” said vascular surgeon Katherine Gallagher, MD, of the University of Michigan, in a statement from the Society.
Patients may not mention an occasional pain in their leg during a busy 15-minute doctor’s visit if they have other concerns about their diabetes. “They might get a leg cramp when they go up the stairs, but then the cramp goes away,” Gallagher said. “It’s not typical for a doctor to ask about PAD or check the pulse in the feet.”
In a press release, the Society recommended the following for individuals with diabetes:
· Walk every day.
· Stop smoking.
· Avoid overexertion. If a person with diabetes experiences pain, bring it up at the next doctor’s visit.
· Don’t skip doctor’s visits. If PAD is diagnosed, a referral to a vascular surgeon will be made.
· Keep numbers under control. Take statins as prescribed.
Humphries MD, Brunson A, Chin-Shang L, et al. Amputation trends for patients with lower extremity ulcers due to diabetes and peripheral artery disease using statewide data. J Vasc Surgery 2016;64(6):1747-1755. http://dx.doi.org/10.1016/j.jvs.2016.06.096.