In the U.S. foot and leg amputations for diabetics have been declining since the mid-1990s. Even as rates of the disease were rising in the United States, fewer foot and leg amputations were being performed on people with diabetes.
“It’s impossible to pinpoint a specific reason for the drop in major amputations. We do know that better foot and ankle treatment is a part of it though,” stated Dr. Phinit Phisitkul, an assistant clinical professor at the University of Iowa department of orthopedics and rehabilitation. MedicalExpress
Between 2009 and 2014 the CDC noticed an increase of 27 percent nationally in the rate of amputations among people with diabetes. Previously, the numbers had been declining.
In California the numbers are shocking – diabetic amputation increased statewide more than 31%. There has been an increase by 66.4% in San Diego County of diabetic amputations.
Clinicians are amputating more toes, legs, ankles and feet of patients with diabetes in California – and San Diego County in particular – in a “shocking” trend that has mystified diabetes experts here and across the country.
Statewide, lower-limb amputations increased by more than 31 percent from 2010 to 2016 when adjusted for population change. In San Diego County, the increase was more than twice that: 66.4 percent.
Losing a foot, ankle or especially a leg robs patients of their independence, hampers their ability to walk and makes them more vulnerable to infection. It also can shorten their lives.
This trend, which inewsource documented with state hospital data, is one physicians, surgeons and public health officials are at a loss to explain, though many have theories.
Edward Gregg of the Centers for Disease Control and Prevention said the California numbers are worrisome.
Public health officials consider amputations to be an important indicator of a region’s diabetes care because diabetes and its complications can be prevented, said Gregg, chief of epidemiology and statistics for the CDC’s Division of Diabetes Translation.
“If we see it going down, then it’s a good sign, because so many aspects of good diabetes care are in theory affected. And when you see it going up, that’s a concern,” he said…
The increase also could be attributed to inadequate attention to diagnosing and managing the disease in some populations, he said, adding that in some populations, there may be less attention to diagnosing and managing the disease.
But those reasons together don’t explain the stark increase in such a short period of time, he said.
The CDC and other experts are stumped at the increase of diabetic amputations in California. There are many theories – aging population, more people being diagnosed, managing the disease in some populations…
Lack of covered treatment
Jonathan Labovitz, a Pomona foot and ankle surgeon and podiatry researcher affiliated with the UCLA Center for Health Policy Research, said some of the blame likely can be traced to 2009 when the state stopped paying for outpatient podiatry services for patients under Medi-Cal, California’s health program for the poor.
State health officials confirmed that Medi-Cal excluded podiatry services as of July 1, 2009 because of the state’s budget shortfall, but said podiatry services are covered when provided by primary care physicians, federally qualified health centers, rural health centers and tribal clinics, and are covered by some Medi-Cal managed care plans. State officials declined to comment on whether the change resulted in an increase in amputations.
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