Diabetic Education Can Save Lives
Regular readers of this column will be well acquainted with the topic of diabetes, and especially some of the lower extremity complications. These facts bear repeating, partially because diabetes is now epidemic, but also because some of the most harmful and dangerous effects of this disease are preventable. I am referring specifically to lower extremity amputations, a life-changing event, in more ways than one.
As a foot and ankle physician, I am on a crusade, of sorts, to reduce the amputation rate, if not state-wide, at least regionally. This is a very achievable goal since we know quite well the “stairway to amputation”, and the chain of events that lead to a lower limb amp. This typically starts with a foot ulceration, which becomes infected. For a number of reasons, diabetics don’t heal these well, despite aggressive medical care. An amputation is sometimes the only available means of saving someone’s life. But up to 85% of these can be avoided, generally by getting proper education, good foot care, and specialized “diabetic” shoes. The way to achieve these necessary and beneficial goals is to get good foot care by a specialized physician, specifically one who treats only that part of the body.
Obviously, I am biased, but it is my belief that no other physician is as well trained in the treatment and prevention of diabetic ulcerations as podiatry. Most diabetologists (experts in diabetes) recommend podiatric care to their patients, if only for monitoring of potential problems. Diabetic foot problems are so much easier to treat early on, before serious complications develop.
In fact, I would go so far as to say that it is in the realm of diabetic foot care that podiatric medicine has its most fundamentally critical effect on health care in America. The total annual cost incurred in treating people with diabetic neuropathy, and the associated complications (with amputation being one of the most severe), is estimated to be $10.9 billion. There is also the loss of productivity, of lost work time. Then you have to add in the expenses of rehabilitation, and the fabrication and training in use of the prosthesis.
But the consequences obviously go far beyond mere dollars and cents, beyond simple medical costs. A diabetic suffers a lower limb amputation every 20 seconds, somewhere in the world. Yes, over four thousand amputations were performed today. And in the ultimate ledger, the statistics are clear: these patients have an incredibly high mortality rate following amputation, ranging from 40% to 80% at 5 years (depending on which study you are reading). You are seeing that correctly: most individuals afflicted with diabetes who suffer an amputation will not survive five years.
Most experts agree that a great majority of these amputations are preventable. Education is a major factor in prevention, as is close and timely inspection of developing problems. Keeping a learned “eye” on these conditions, and treating them before they become more serious, by all appropriate methods, are critically important ways that are known to reduce the risk of amputation. No other physician is as well trained in recognizing those areas of impending ulceration, reducing the pressure leading to it, and educating the patient about how to care for their feet, as a modern-day podiatrist.
Some critical steps that a physician should perform for their diabetic patients include all of the following: the aforementioned education, reducing the thickness of chronic calluses, prescribing healthy shoe gear, optimizing skin health, timely ulcer care, and, when it will prevent the development of an ulcer (and all the associated morbidity and mortality), a surgical procedure. Regardless of which physician performs these essential tasks, if you have diabetes, get evaluated for neuropathy, which precedes most diabetic ulcerations. As has been written previously, the more you know, the better you’ll do!