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Evidence-Based Diabetes Management
Contributor: Increasing Awareness About Peripheral Artery Disease Can Save Limbs and Lives
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A commentary from a cardiologist who practices in the Mississippi Delta, where a comparatively high share of the population is at risk for diabetes and peripheral artery disease.
With the holiday season in full force, most Americans are looking forward to feasting with family and friends and taking a much-needed break from work.
However, for the more than 30 million US individuals living with diabetes and the 84.1 million living with prediabetes,1 the consumption of unhealthy food and long periods of inactivity during the season can make symptoms worse.
Diabetes is a public health crisis, costing $327 billion per year, according to the most recent analysis from the American Diabetes Association.2 As many as 1 in 3 US adults could have diabetes by 2050 if current trends continue, according to an analysis based on CDC data.3 Racial and ethnic minorities have a higher prevalence of the disease and a greater burden compared with white individuals, as disparities in health and healthcare lead to higher rates of complications in minority populations. Unfortunately, these communities may lack awareness of complications and the symptoms that can signal a need for medical attention.
One important complication of diabetes is atherosclerosis. Atherosclerosis refers to the hardening of the arteries and the accumulation of fatty deposits within them. Arteries are
delicate tubes that carry blood with oxygen and nutrients to all parts of the body. As such, there is no room for plaque, which narrows these vessels and restricts the blood flowing
through them. Severe narrowing can block blood flow to areas such as the brain, the heart, and the legs, leading to devastating results, especially if affected individuals do not recognize the symptoms in time to get help. A lack of blood flow can cause the death of heart muscle; if the brain is affected, a stroke can occur; and reduced flow in the legs can lead to pain, poor healing of diabetic ulcers, gangrene, and eventual amputation.
Atherosclerosis that affects the limbs is called peripheral arterial disease (PAD), the complication that has been shown to cause the most significant long-term disability and economic burden in patients with diabetes. It is estimated that 1 in 3 people 50 years or older with diabetes has PAD, yet millions of people with the disease do not realize they are at risk for losing a limb until it is too late.4 Someone is given a diabetes diagnosis every 17 seconds in the United States, and every day, 230 Americans with diabetes will suffer an amputation.5 Each year, approximately 200,000 nontraumatic amputations occur in the United States. African Americans are 4 times more likely to experience diabetes-related amputation than white individuals, and it is estimated that throughout the world, a leg is amputated every 30 seconds; 85% of those amputations are the result of a diabetic foot ulcer.6 Unfortunately, even as the diabetes and PAD epidemics worsen, people do not recognize the symptoms. Early detection and treatment of PAD is crucial to saving limbs. With timely screening, in-depth assessment of symptoms, and thorough physical examinations, millions of amputations can be prevented. Like cancer, PAD must be caught early and treated to prevent progression and suffering. It is often asymptomatic in its early stages, making ultrasound screenings a lifesaving necessity.
As a limb salvage specialist, I am committed to educating and providing quality healthcare to prevent the loss of limbs. Early screening, diagnosis, and intervention save legs and thus preserve quality of life. More important, they save lives, as 50% of patients with diabetes who experience amputation will die within 2 years of the amputation.7
To help prevent complications from diabetes and PAD, it is important for everyone to manage this disease every day. A little physical activity goes a long way in soothing leg pain and keeping blood flowing to the legs and feet. Controlling blood sugar, knowing your glycated hemoglobin number, and eating a well-balanced diet designed for those with diabetes can significantly reduce the risks for PAD and amputations. By quitting smoking, individuals can also greatly reduce their risk for PAD.8
On a national scale, I recently joined a group of advocates in Washington, DC, to call on lawmakers to adopt a national strategy to increase public awareness of PAD. This distinguished group of advocates included both physicians and patients who have endured amputations and who had a shared mission to change policy to help prevent unnecessary limb loss. PAD advocates are asking the Trump administration to convene an intragovernmental workgroup to develop a standardized model for amputation reduction and to raise awareness of this critical issue.
Regardless of whether people with diabetes feel leg pain, they should be encouraged to talk with their doctor and be screened for PAD. Physicians should take patients’ shoes off at every appointment and teach patients to examine their own feet. Helping patients take control of their health could literally save limbs—and lives. Author Information
Foluso A. Fakorede, MD, is a practicing cardiologist and CEO of Cardiovascular Solutions of Central Mississippi as well as cochair of the PAD Initiative for the Association of Black Cardiologists.References
1. CDC. National Diabetes Statistics Report, 2017. cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Published 2017. Accessed December 2, 2018.
2. American Diabetes Association. Economic costs of diabetes in the US in 2017. Diabetes Care. 2018;41(5):917-928. doi: 10.2337/dci18-0007.
3. Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality and prediabetes prevalence. Popul Health Metr.2010;8:29. doi: 10.1186/1478-7954-8-29.
4. Peripheral arterial disease (PAD). American Diabetes Association website. diabetes.org/living-with-diabetes/complications/heart-disease/peripheral-arterial-disease.html. Updated September 24, 2014. Accessed December 2, 2018.
5. Yost M. The burden and economic cost of peripheral artery disease. Presented to: New Cardiovascular Horizons; October 13, 2018; Minneapolis, MN. bit.ly/2DYI0ls. Accessed December 2, 2018.
6. Diabetic wound care. American Podiatric Medical Association website. www.apma.org/Patients/FootHealth. cfm?ItemNumber=981. Accessed December 2, 2018.
7. Brownrigg JRW, Apelqvist J, Bakker K, Schaper NC, Hinchliffe RJ. Evidence-based management of PAD & the diabetic foot. Eur J Vasc and Endovasc Surg. 2013;45(6):673-681. doi: 10.1016/j.ejvs.2013.02.014.
8. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic). Circulation. 2006;113(11):e463-e654. doi: 10.1161/CIRCULATIONAHA.106.174526.
