More than 35 million Americans have been diagnosed with diabetes, and the country spends $327 billion a year to treat it. But what’s less commonly discussed are the complications, which can range from cardiovascular problems to vision impairment to kidney disease.
But among the most debilitating of these side effects is diabetic foot complications, which account for one-third of diabetes expenditures.
The reason there is such a great expense is that, despite being largely preventable, these complications often go untreated for far too long, which can then require more extreme interventions: amputations.
Patients with major amputations lose their ability to move around and feel independent; it’s a serious detriment to their quality of life. Research has shown that patients with diabetic foot complications fear amputations more than death. This may be, in part, because amputations are highly correlated with death: The five-year mortality rate for someone who has a diabetic amputation is as high as 80%.
And because those with fewer resources typically lack access to preventive care, underserved patients disproportionately suffer from amputations. Previous research has shown that those in low-income communities and the African American community are up to three times more likely to require a diabetic amputation. Some of healthcare’s most prominent advocacy groups have taken notice; for example, the American Diabetes Association recently listed “The Right to Avoid Preventable Amputations” in their Health Equity Bill of Rights.
Unfortunately, even after an amputation, patients remain at risk for subsequent amputations. In fact, recently published research in BMJ Open Diabetes Research & Care found that nearly 20% of diabetes patients suffer another amputation within one year of their first surgery and nearly 40% do so within five years. That number is shockingly high, and there has been virtually no improvement in this rate in two decades.
The reasons for this lack of progress in preventing amputation, whether it is the first, second, or third for a given patient, are varied. For one, the key to avoiding amputations is catching problems early through preventive medicine, which is often underutilized.
In traditional fee-for-service payment structures, payment is proportional to the number of services performed, creating limited to no financial incentives for preventive measures delivered. In fact, this lack of preventive care is commonly considered one of the biggest drivers of waste in the system.
The good news is that innovative solutions that can detect these problems early in the process exist, and in increasingly common value-based care models, providers and payers do have an incentive to invest in preventing problems like diabetic foot complications before they worsen and become costlier to treat.
Diabetic foot complications are a growing problem despite the fact that we can identify individuals most at-risk and there is technology available to prevent them. The logical conclusion, then, is that the healthcare system needs to devote more resources to ensuring these technologies are accessible to the people who stand to benefit the most so they can remain standing on their own two limbs.
This new research on diabetic amputations is really a wake-up call about the need for preventive care for the diabetic foot that works.
Jon Bloom, M.D., is the CEO of Podimetrics.