Reamputation Rate Remains High in People With Diabetes

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Reamputation Rate Remains High in People With Diabetes

Among people with diabetes who undergo an amputation of a lower extremity — a toe, foot, or greater part of the leg — a large proportion will require another amputation within a handful of years, according to a new analysis published in the journal BMJ Open Diabetes Research & Care.

What’s more, this reamputation rate appears to be unchanged for decades, raising the question of why no progress has apparently been made in this area. Amputations are universally regarded as an outcome that should be avoided if at all possible, and tend to be done only when healing of a wound in someone’s foot or leg is so poor that not amputating the extremity could be life-threatening due to the risk posed by infection. Amputations are expensive, often require a long and unpleasant recovery period, and often leave someone with a significant degree of disability.

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Diabetes complications can include nerve damage and poor blood circulation, which make feet vulnerable to ulcers that, if left untreated, can lead to amputations,” said article author David Armstrong, MD, a professor of surgery at the University of Southern California and founder and co-director of the Southwestern Academic Limb Salvage Alliance, in a press release. “After an amputation, an individual’s mobility is reduced, causing his or her overall health to deteriorate.”

Concerning reamputation rates

The analysis was initiated by Podimetrics, a virtual care management company that aims to prevent diabetes-related amputations. It looked at 22 studies on amputations exclusively in people with diabetes, in which a total of 21,145 initial amputations took place. After one year, the reamputation rate among people who had an initial amputation was 19% — already a large enough number to raise concerns. After five years, the reamputation rate was 37.1%. The rate for amputations on the opposite side of the body as the previous amputation was 20.5%, accounting for more than half of all reamputations after five years. The studies included in the analysis spanned more than 20 years, and over this time period, the researchers found no evidence of a trend toward fewer (or more) reamputations, despite numerous advances in wound care and diabetes treatments during the same period of time.

When it comes to amputations in people with diabetes, “This is a problem that should be entirely preventable in the first place, so it’s mind-blowing to see that after an amputation … four out of ten patients have another,” Armstrong laments in the press release. The press release also notes that lower-limb problems account for about one-third of the $245 billion spent to treat diabetes each year in the United States, which means that early detection of foot problems could save potentially billions of dollars in medical costs each year if effective interventions could prevent initial amputations or reamputations.

Technology could play a promising role in preventive care for feet that might reduce the need for amputations. Podimetrics created a device called the SmartMat, which scans the feet of people at higher risk for foot problems in 20 seconds and sends data to their healthcare team, which can follow up on any concerning findings. More research is needed though, to determine whether this approach — or any other new protocols for foot care — leads to a substantial reduction in amputations.

Want to learn more about keeping your feet healthy with diabetes? Read “Caring for Your Feet When You Have Diabetes,” “How to Choose Footwear” and “Improving Blood Flow to the Feet.”

Living with type 2 diabetes? Check out our free type 2 e-course!

Quinn Phillips

Quinn Phillips

Quinn Phillips on social media

A freelance health writer and editor based in Wisconsin, Phillips has a degree from Harvard University. He is a former Editorial Assistant for Diabetes Self-Management and has years of experience covering diabetes and related health conditions. Phillips writes on a variety of topics, but is especially interested in the intersection of health and public policy.

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