March 2011

CDC Estimates More Than 8 Percent In U.S. Have Diabetes

By Brian McCurdy, Senior Editor

The number of Americans with diabetes continues to escalate. Approximately 25.8 million people have diabetes, about 8.3 percent of the United States population, according to new estimates from the Centers for Disease Control and Prevention (CDC). This is an increase of 2.2 million people since the last CDC estimates released in 2007. The new total includes 7 million people who are unaware that they have the disease.

   In addition, the CDC notes that 79 million people 20 years of age or older — or 35 percent of those 20 years of age or older — have pre-diabetes in comparison to 57 million people 20 years of age or older in 2007.

   Both Stephanie Wu, DPM, and Ronald Sage, DPM, attribute the rising prevalence of diabetes and pre-diabetes to a sedentary lifestyle and unhealthy eating habits, which lead to obesity, the number one risk factor for type 2 diabetes. Dr. Wu cites statistics from the National Center for Health Statistics showing that nearly 30 percent of adults in the United States are obese. Dr. Sage adds that a diet high in calories and carbohydrates sets people up for metabolic syndrome. He notes that metabolic syndrome is characterized by obesity and glucose intolerance, and leads to pre-diabetes.

   Dr. Sage notes preventive methods for patients with pre-diabetes include a general physical examination to identify risk factors such as hyperglycemia, elevated blood pressure, lipid abnormalities and elevated body mass index. Treatment may include exercise, lifestyle modifications and medication, says Dr. Sage, a Professor and the Chief of the Section of Podiatry at the Department of Orthopaedic Surgery and Rehabilitation at the Loyola University Stritch School of Medicine in Maywood, Ill.

    “Losing a modest amount of weight (5 to 10 percent of total body weight) through diet and moderate exercise (walking 30 minutes a day, five days a week) can make a big difference,” says Dr. Wu, an Associate Professor of Surgery at the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science in Chicago. Since people with pre-diabetes have a 50 percent increase in risk for heart disease or stroke, she emphasizes treatment for hypertension and high cholesterol.

   In addition to obesity, Dr. Wu cites other risk factors for diabetes like increased age, a family history of the disease, ethnicity, hypertension, hypercholesterolemia and gestational diabetes. Modifiable risk factors for diabetes include smoking and high alcohol consumption, according to Dr. Wu.

Emphasizing Increased Awareness Of The Disease

To prevent the spread of diabetes, Dr. Wu acknowledges the importance of educating patients on diabetes and its devastating complications. She notes that many patients have no idea they even have diabetes until they go to the emergency room with a diabetic foot infection. She and Dr. Sage advocate having ad campaigns as well as news and magazine articles that address diabetes prevention. Dr. Sage also suggests supporting organizations like the American Diabetes Association (ADA) in informing the population about the seriousness of diabetes.

   Dr. Wu also suggests incorporating diabetes awareness into the education of young children and their parents.

    “Childhood obesity is becoming problematic in the U.S. and educating the young and their parents to make healthy food choices and be more active will help. Basically, increasing awareness of the disease overall will help prevent spread of the disease,” says Dr. Wu.

Do Socioeconomic Factors Influence The Quality Of CLI Care?

By Brian McCurdy, Senior Editor

A recent study in the Journal of Vascular Surgery suggests that the poor and minorities may be more likely to undergo amputation for critical limb ischemia (CLI).

   The study authors examined the 2003-2007 Nationwide Inpatient Sample for a total of 958,120 patients with CLI who were discharged after undergoing lower extremity revascularization or a major amputation. The study found that minority patients with CLI tended to have less insurance coverage, lower incomes and were more likely to be treated at under-resourced facilities. The authors also found that minority patients with CLI had more comorbidities such as renal failure and diabetes that impacted available treatment options. The authors concluded that minorities, patients with lower socioeconomic status and those with Medicaid were more likely to undergo amputation for CLI.

   The most prevalent socioeconomic predictor of amputation for CLI is poorly controlled diabetes, notes Alan Catanzariti, DPM, a Fellow of the American College of Foot and Ankle Surgeons. Patients might be uneducated about the disease, cannot afford appropriate care or are non-adherent, factors he says “clearly place them at greater risk for complications secondary to CLI.” He cites additional factors such as smoking and a lack of access to podiatric care.

   How can the profession best address patients’ socioeconomic factors? Dr. Catanzariti suggests tackling access to physicians and the affordability of healthcare.
“Podiatrists are a huge part of the solution because we provide the services that protect at-risk patients,” says Dr. Catanzariti, the Director of Residency Training in the Division of Foot and Ankle Surgery at Western Pennsylvania Hospital in Pittsburgh. “Additionally, the podiatrist is often the initial healthcare provider who makes the diagnosis of CLI.”

Poll: Opinion Split On Seeing Medicaid Patients

By Brian McCurdy, Senior Editor

A recent Podiatry Today online poll (see http://bit.ly/gBPae0 ) reveals a wide range of opinions on whether podiatrists are altering their treatment of Medicaid patients due to reimbursement issues.

   Of the 301 respondents, 37 percent said they are still seeing Medicaid patients while 36 percent have stopped participating in Medicaid altogether. Fourteen percent only see Medicaid patients via referrals, 10 percent have stopped seeing new Medicaid patients and 3 percent no longer perform elective surgery on Medicaid patients.
Patrick DeHeer, DPM, was surprised that 37 percent of those polled still see Medicaid patients without restrictions.

    “I do not think this is financially responsible. The practitioners would be better served seeing these patients in a free clinic setting as a volunteer in my opinion,” notes Dr. DeHeer, who previously blogged for Podiatry Today about the topic (see http://bit.ly/fYIhaR ).

   Jonathan Moore, DPM, is among those who is still seeing Medicaid patients and does not plan to re-evaluate that decision. His practice offers Medicaid patients ancillary services such as physical therapy, durable medical equipment, a shoe store and neurovascular testing, which he says allows the practice to “practice comprehensively, get people well and remain financially strong.”

   Like other physicians, Dr. Moore notes he is getting paid less and says Medicaid patients are most in need of medical care.

    “We thankfully have not been cut from being able to be reimbursed for our services but if it happens, we will survive,” says Dr. Moore, who is in private practice in Somerset, Ky.

   What could help solve the reimbursement issues with Medicaid? Dr. DeHeer, who practices at Hoosier Foot and Ankle in Carmel, Ind., thinks if the federal program’s reimbursement and guidelines were similar to that of Medicare, more physicians would be willing to participate in Medicaid without reservations.

Comments

There is an abundance of material in the podiatric literature largely directed to podiatrists by podiatrists and for podiatrists. The trends in general mainstream medicine integrating some commonly used modalities seems somewhat lost on podiatrists. The use of sildenafil, an ED drug and a PDE-5 inhibitor, has remarkable effects for peripheral neuropathy and Raynaud's.

Why isn't this in the podiatry literature? It is remarkable how the cabal of podiatry remains in its shell while mainstream medicine integrates knowledge. Perhaps the limitations of license preclude podiatrists from exploring modern medical procedures or perhaps a general self imposed ignorance. It appears the stubborn nature of podiatry and its place in medicine, misunderstood as it is, will ultimately disappear,

Will podiatry survive a cure for diabetes?

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