Diabetes can lead to numerous serious complications. It is a major risk factor for stroke and heart attack. Diabetes can damage the retina and is the leading cause of new cases of blindness in the US. It can damage the kidneys and is the greatest cause of need for dialysis. It can also cause nerve damage leading to numb or painful feet.

But few potential complications evoke as much fear in my patients as foot amputations. Though many injuries and accidents lead to amputations, diabetes is the most frequent cause of nontraumatic foot amputation. Diabetes leads to limb loss through multiple mechanisms. It leads to atherosclerosis, cholesterol plaques in arteries, which limit circulation to the limbs. It leads to nerve damage which can cause wounds to go unnoticed. And it weakens the immune response so that infected wounds are very difficult to treat.

The good news this week is that amputations due to diabetes have become much less frequent. A study conducted by the Centers for Disease Control and published in Diabetes Care reviews nontraumatic lower extremity amputations in diabetics between 1996 and 2008. In those twelve years the frequency of amputation in diabetics declined by two thirds.

Many helpful trends are responsible for all those saved feet. Diabetes is typically diagnosed earlier and treated more aggressively now than in the mid 90s. Several of the medications used for diabetes now were unavailable then. Atherosclerosis treatment also continues to improve with recognition of the importance blood pressure control and of cholesterol lowering with statins. The importance of meticulous foot care by diabetic patients is better understood, and the management of diabetic wounds by multidisciplinary teams is becoming the standard of care.

So in a week in which the news appears monolithically depressing I thought I’d spread some good news. Chances are you know someone with diabetes. Chances are that he will continue to lace both of his shoes for his whole life.

Learn more:

CDC report finds large decline in lower-limb amputations among U.S. adults with diagnosed diabetes (CDC Press Release)
Lower-limb amputations have declined among diabetics (Los Angeles Times Booster Shots)
Rate of Leg, Foot Amputations Among Diabetics Drops: CDC (US News & World Report)
Declining Rates of Hospitalization for Nontraumatic Lower-Extremity Amputation in the Diabetic Population Aged 40 Years or Older (Diabetes Care)

Tangential Miscellany

Dr. Kevin Pho, the very well known physician blogger and outspoken advocate of social media in medicine, is publishing some of my posts.