Diabetes is an insidious and devastating disease. It affects every system in the body and the prevalence of this disease is on the rise throughout the world in epidemic proportions.
Currently, 5,200 people in the United States are diagnosed every day with diabetes.1 In addition, 230 limbs are amputated every day as result of diabetes, 133 people go on dialysis every day from diabetes and 55 people go blind every day from diabetes.
On the present course, one of every three people in the world will have diabetes by the year 2030 and the U.S. population will reach that number by 2050.1
A Closer Look At What Patients With Diabetes Face
Diabetes is associated with the devastating result of lower extremity amputation, which is preceded by the development of a foot ulcer. In fact, some 84 percent of those with diabetes who undergo a lower extremity amputation also have a history of foot ulcers.1
In the U.S., more than 73,000 lower extremity amputations occur each year. Amputation occurs 10 times more frequently in those with diabetes than those without the disease.2,3 The primary reason for patients with diabetes to be admitted to the hospital is an infected diabetic foot ulcer (DFU). Worldwide, every 30 minutes, a person loses a leg to a land mine. Similarly, every 30 seconds, a leg is amputated because of diabetes.2
In addition to pain and reduced quality of life, three of five patients with diabetes and a lower extremity amputation will die within five years of the first amputation. About 34 percent of those with a lower extremity amputation will have a second, more extensive amputation within 16 weeks of the initial amputation, indicating that patients with diabetes may have a persistent inability to heal.3
The cost of treating a lower extremity amputation and its complications is equally staggering. Annually, DFUs cost nearly $40 billion in the U.S.1 In 2012, treating diabetes and related complications reached a staggering $245 billion in the U.S. with direct costs of $176 billion and indirect costs (disability, work loss and premature death) of $69 billion. These numbers are expected to grow rapidly as the number of people diagnosed with diabetes increases. Out of 30 million patients with diabetes now in the U.S., 8.1 million people do not know they have diabetes and 80 to 90 million more people have pre-diabetes.1
Obesity leads to the initiation and progression of type 2 diabetes, and its devastating complications. One out of every three children in the U.S. is obese, which will lead to a frightening rise in newly diagnosed young people with diabetes.4 Other risk factors for diabetes include smoking, physical inactivity, high blood pressure, high cholesterol and high blood glucose.1 Diabetes can also be hereditary as African-Americans and Latinos have a higher greater incidence than Caucasians and Asian-Americans.
For people between the ages of 20 and 79, the mortality rate from diabetes and related complications is nearly 20 percent, but this number may be even higher since the death rate from diabetes is vastly underreported as the primary cause of death. Studies have shown that just 35 to 40 percent of death certificates list diabetes as the primary cause when, in reality, diabetes is the primary cause of death in well over 70 percent of these cases.1
Getting The Dire Warnings About Diabetes Through To Patients
Why do people with diabetes and the broader public not understand the need to detect, diagnose and treat this disease? Diabetes knows no boundaries. It does not discriminate, does not care if you are African-American, Caucasian or Hispanic. It doesn’t distinguish man, woman or child, rich or poor, where you live or how you live. The bottom line is that diabetes wants to kill you.
Why aren’t we seeing more advocacy, urgency and outreach for spreading the word about diabetes and its devastating complications? Why aren’t more professional athletes and their respective associations waving the green flag of diabetes during sporting events?
When people learn they are diagnosed with cancer, there is a sense of urgency to seek treatment without delay. However, when the diagnosis is diabetes, there is no comparable sense of urgency since signs of the disease are delayed. Many people think taking a pill or having an injection will control and cure diabetes. That is often a fatal mistake.
Most patients don’t know of these frightening numbers, don’t read of diabetes, don’t hear celebrities talking about it and certainly do not hear our government leaders advocating for treating diabetes and its causes. Why should patients be concerned?
Patients don’t know diabetes is the primary cause of blindness, kidney failure and non-traumatic lower extremity amputation throughout the world.1 They don’t know having a DFU in the presence of peripheral vascular disease leads to a higher death rate than breast, prostate, colon and lymphoma cancers combined.1
In my own practice, it amazes me that patients do not know of these complications with diabetes. They don’t even know about the correlation of diabetes with severe cardiovascular events. We discuss seeing diabetes educators, nutritionists and dieticians at the hospital. Those visits are covered by insurance with a prescription from me. I tell patients to go to the American Diabetes Association (ADA) website as it has hundreds of pages of information.5
I discuss with patients the role of nutrition and the need for antioxidants in their diets as well as vitamin supplementation, like vitamin D3, vitamin C, fish oil, alpha lipoic acid, pycnogenol and turmeric. It can be demanding as very few patients know anything about nutrition and how to modify their diet in accordance with managing diabetes. It is very disheartening. Patients feel very overwhelmed and abandoned.
If people from all walks of life do not begin to comprehend the seriousness and the urgency in spreading the word about diabetes and its complications not only to patients, but also the public with particular emphasis on adolescents, then we should start building more hospitals, making more prostheses and developing more cemeteries.
Dr. Regulski is the Director of the Wound Institute of Ocean County, NJ. He is a partner of Ocean County Foot and Ankle Surgical Associates, and a member of the American Podiatric Medical Association.
1. CDC Division of Diabetes Translation, National Diabetes Surveillance System. Available at http://www.cdc.gov/diabetes/statistics.
2. Bharara M, Mills JL, Suresh K, Rilo HL, Armstrong DG. Diabetes and landmine-related amputations: a call to arms to save limbs. Int Wound J. 2009; 6(1):2–3.
3. Margolis D, Gupta J, Mitra N, Townsend R, et al. Variants in genes belonging to the fibroblast growth factor family are associated with lower extremity amputation in non-Hispanic whites. Findings from the chronic renal insufficiency cohort study. Wound Repair Regen. 2016; 24(4):705-711.
4. American Heart Association. Obesity information. Available at http://www.heart.org/HEARTORG/HealthyLiving/WeightManagement/Obesity/Obesity-Information_UCM_307908_Article.jsp#.WmYpdUtG1GM . Accessed January 19, 2018.
5. American Diabetes Association. Available at http://www.diabetes.org/diabetes-basics/statistics/?loc=db-slabnav . Accessed January 19, 2018.
Editor’s note: For further reading, see the DPM Blog “A Call To Action To Lower The Rising Diabetes-Related Amputation Rates” at https://tinyurl.com/yct4r8up, “The Multidisciplinary Team Approach To The Diabetic Foot” in the June 2016 issue of Podiatry Today, or “Emerging Keys To Improving Diabetes Self-Management For Patients” in the January 2017 issue. To access the archives, go to www.podiatrytoday.com.