Diabetes mellitus is a serious condition in which patients have high blood glucose levels due to defective insulin production or action, which leads to inadequate blood sugar control. This is a chronic, progressive disease and can lead to life threatening complications such as heart disease, stroke, kidney failure, nerve damage, and even blindness.
In the US, almost 19 million people have diabetes. It is also estimated that a further 7 million people have undiagnosed diabetes, and 79 million are prediabetic. Amazingly, the number of adults with diabetes worldwide has already doubled since 1980, and the Centers for Disease Control and Prevention predict that as many as one third of American adults could be diabetic by 2050 if current trends continue.
The Diabetic Foot Ulcer
The diabetic foot ulcer (DFU) represents a marker of fatal disease, since almost 50% of people with unhealed DFUs die within 5 years. In comparison, the 5 year mortality rate for women with breast cancer is 14%.
DFUs are a major complication of diabetes, and are responsible for more hospitalizations than any other diabetic complication. They tend to be located on the ball or sides of the foot, or the underside of the big toe. Most cases of DFU result from minor trauma and structural deformity in the presence of peripheral neuropathy. Calluses and peripheral arterial disease are also underlying risk factors in the development of DFUs.
The Shocking Statistics
- 12% of patients with diabetes have foot ulcers
- 60% of all lower limb amputations occur in patients with diabetes
- Diabetes results in the amputation of about 65,700 legs or feet each year in the US
- 85% of these lower limb amputations in diabetics are preceded by a foot ulcer
- 85% of amputations may be preventable if recognized earlier and treated aggressively
- $4 billion annually could be saved with a 25% reduction in amputations
The Save A Leg, Save A Life Foundation
I recently came across the “Save A Leg, Save A Life” Foundation (SALSAL). This national, non-profit organization was founded several years ago to promote a team approach to treating wounds.
Its mission statement is: “To reduce the number of lower extremity amputations and to improve the quality of life for our fellow citizens who are afflicted with wounds and complications of diabetes and peripheral arterial disease.We will accomplish these goals by educating professionals, students and patients through advanced evidence based methods and through community outreach.”
It brings together specialists such as podiatrists, vascular surgeons and wound-care experts, aiming to encourage health professionals to act quickly to deal with underlying medical issues. For this concept to work best, primary care physicians need to see this organization as an effective resource to help their patient. Maybe a vascular surgeon needs to open up narrowed arteries first to improve blood flow, or maybe a podiatrist needs to address structural problems of the feet. Whatever the underlying issue, doctors should refer patients to the appropriate specialists before problems become too advanced to repair. After all, a delay of a few weeks can mean the difference between losing or saving a limb.
Luckily, current technology now allows for improved wound healing and limb salvage for many patients, where amputation previously was the only consideration. “Amputation should not be considered as a treatment option, but as a treatment failure” says Dr Yazan Khatib, a cardiologist and co-founder of SALSAL.
“If you have a DFU that leads to a major amputation, your risk of death in five years is greater than that of breast cancer and prostate cancer combined,” comments Dr David Schwegman, co-chair of the Atlanta chapter of SALSAL.
Local chapters of the organization exist in many regions, and these are a good way to educate other physicians on best practices, to collect data on the outcomes of treatments, and to reduce duplicative medical services
So if you, or someone you know, suffers from diabetes, visit the SALSAL website and spread the word. And don’t be afraid to mention it to your physician.
Your words could help save a limb. Wouldn’t you like to help keep someone’s feet healthy?