A new study by Geiss from Diabetes Care reveals a disturbing trend toward increasing rates of lower extremity amputations in young (18-44 y/o) and middle-aged (45-64 y/o) diabetic patients. This comes after a two-decade long decline in amputation rates in all diabetic patients. The study noted this upward spike in data collected from 2010-2015 in the US. As to the potential causes for this finding, the authors suggest a “fundamental failure” in amputation prevention. They go on to note:
“Many amputations may be avoided through attention to self- and clinical care practices to manage risk factors, including glycemic control and cardiovascular disease risk factors, and through early detection and appropriate treatment of foot ulcers .
Increasing rates of NLEAs (non-traumatic lower extremity amputations), particularly minor amputations, suggest either early prevention practices (e.g., self management education, appropriate footwear, foot exams, and identification of high-risk feet) might not be optimally performed to prevent foot ulcers and/or there may be delays in timely treatment of ulcers.”
Indeed, this systemic failure to prevent these tragic events is a recurring frustration well known to those treating diabetic patients. An aggressive team-based approach incorporating primary care, podiatry, diabetes educators, vascular surgeons, nutritionists and wound care specialists is required in addition to active and willing patient participation. Additionally, the importance of aggressive early prevention cannot be over emphasized. This is germane in the diabetic foot with regard to early detection of diabetic neuropathy. The graphic below illustrates the concept well. In essence, the earlier neuropathy is diagnosed, the earlier prevention can be implemented to avoid amputations. A worthy goal for patients and providers alike.
Earlier diagnosis of neuropathy indicated by the yellow arrow could help avoid amputations through earlier preventative intervention.
In contrast, current guidelines focus on identifying Loss of Protective Sensation (LOPS) as a trigger for prevention.