Diabetic limb amputation epidemic in poor communities and parts of Cleveland: Lee Kirksey

CLEVELAND – Differences in outcomes by race, ethnicity, and income exist for virtually every chronic health condition that Americans experience. Without exception, white minority and poor Americans die younger and suffer more from preventable diseases.

November is diabetes awareness month. Few diseases impact every system in the body the way diabetes increases the risk of stroke, heart attack, and kidney failure.

Among these devastating conditions, limb loss or amputation is one of the most feared complications of diabetes. Every four minutes a limb is amputated somewhere in the United States, and each year 150,000 Americans have an amputation. Up to 25% of patients during their diabetic state will develop a foot ulcer which, if not detected and treated, can lead to infection and amputation.

Every diabetic patient I know has told me that amputation is their biggest fear. And many of them even told me that, having to choose between the prospect of an amputation or their life, they would rather die. The amputation of a limb has a dramatic impact not only on the life of a patient but also on the lives of those around him. Too often this takes the individual out of the workforce and creates economic distress for the whole family. In addition, it changes the way the affected person engages with their loved ones and the community. For this reason, depression is a common feature.

Amputation is avoidable by realizing the need for a healthy diet, exercise, reliable blood sugar control and a routine foot exam by a patient, family or health care provider. A change in government policy is also needed. My department at the Cleveland Clinic was involved in the creation of a congressional bill, The Amputation Reduction and Compassion Act, which seeks funds to improve public awareness and early detection of disease.

Diabetes, like COVID-19, disproportionately affects the most vulnerable Americans. The American Diabetic Association has created a Health Equity Bill of Rights. The Bill of Rights emphasizes both the need and the law for all communities to have affordable anti-diabetic drugs like insulin and access to healthy foods. It is important to note that evidence-based nutrition education should be a compulsory component of the early childhood and adolescent curriculum. Many lifestyle behaviors that lead to diabetes are developed at an early age and, as the saying goes, “an ounce of prevention is better than a cure”. Structural changes such as eliminating sugary foods and drinks are an important step towards creating a healthier work and school environment.

Some postcodes in Cleveland are associated with two to three times the limb amputation rates. It is not surprising that these communities also display higher rates of socioeconomic distress and poverty. Improving access to high-quality, uninterrupted and consistent health insurance coverage and primary care from an early age is essential if we hope to improve diabetes care and eliminate the epidemic of leg amputations in the elderly. underfunded communities.

So it is once again that we must shed light on health care as a fundamental human right which must be equitably accessible in all communities, urban or rural, to meet the needs of our most vulnerable populations.

Dr Lee Kirksey is a vascular surgeon and community health advocate at the Cleveland Clinic with a special interest in reducing health disparities.

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