Diabetes is a disease affecting multiple systems of the body. A long history of poor compliance with diabetes management, lack of education, alcohol abuse, smoking, social isolation, foot deformities, limited mobility, delays in seeking or receiving treatment and inappropriate or ill-fitting footwear increase the risk that life-threatening infections will occur in the lower limbs. Amputation may become necessary.
Predisposing Factors
Over time, high blood sugars associated with diabetes damage blood vessels, nerve fibers and impair circulation. Nerve damage causes neuropathy, a condition of numbness or pain, and the loss of protective sensation in the feet. The diabetic may be unaware of blisters or other minor injuries. Once the skin is broken, sores on the feet may not heal due to poor circulation. Without prompt attention, the Mayo Clinic warns that infection rapidly sets in and may quickly progress to the point where infected tissue dies and gangrene develops. The Centers for Disease Control and Prevention (CDC) confirms that neuropathy is a major contributor to diabetic amputations.
Prevalence
From 2005 statistics, the CDC estimated that over 20 million people in the United States have diabetes. Nerve damage is a complication for 60 to 70 percent of diabetics. Excepting those caused by accidents or traumatic injury, 60 percent of lower limb amputations are due to diabetes. In 2002, there were 82,000 limbs lost to the effects of the disease.
Mortality
Researchers at the University of Texas Health Science Center, in an article published in the October 2001 "Diabetes Care," report that 5 to 10 percent of diabetic amputees die during hospitalization, and that 50 percent die within five years. The risk of developing subsequent foot ulcers, or of requiring a second amputation, is increased by altered mobility that causes greater pressure on the remaining toes, parts of the foot, or other foot. Many diabetics have poor vision, which further complicates self-care.
Effects
Depression is common after diabetic amputation, according to an article by internist and endocrinologist W.H. van Houtum, of Spaarne Hospital Hoofddorpe, Netherlands. In his article published in the September 2005 issue of "Diabetes Voice," Dr. van Houtum suggests that depression stems from fear of repeated infections, disability, and dependence on others.
Prevention/Solution
Van Houten states that 49 to 85 percent of diabetic amputations can be prevented by protective footwear. The Mayo Clinic advises diabetics to clean, dry and inspect their feet daily, have regular checkups, quit smoking and avoid going barefoot. Any reddened areas or breaks in the skin of the lower limbs should be evaluated promptly by a doctor. The most important factor in the prevention of diabetic complications, such as lower limb amputation, is careful blood sugar control using diet, exercise, monitoring and appropriate medication.
References
- Mayo Clinic: Amputations and Diabetes
- CDC: National Estimates on Diabetes
- "Diabetes Care", Functional Status of Persons With Diabetes-Related Lower-Extremity Amputations, Peters E, et.al., October 2001, 24(10)
- "Diabetes Voice", Key Aspects of Care After a Lower Limb Amputation, van Houtum WH, Sept 2005, 50(3)
