A Review of the Relationship Between Diabetes and Diabetic Amputations in the United States: An Expensive, Chronic but Preventable Condition

The number of people living with diabetes is expected to increase to 250 million worldwide by 2025. Diabetes is a chronic condition that requires constant care. Not everyone has the financial means to upkeep their diabetic care. When diabetes becomes unmanageable, it often causes unknown infections, or ulcers, which can lead to the need for amputation. This increase in type 2 diabetes largely contributes to the near doubling of the current amputated population in the U.S. As of 2004, 68 percent of major amputations were due to diabetes. This is especially an issue because people with diabetic amputations not only have to deal with an amputation, but also with a chronic illness that they have difficulties managing. Most studies look into the cost of surgery and prosthetics, which is easily tens of thousands of dollars. However, previously completed studies have not looked into the indirect costs and productivity losses, which excludes the costs on the family and society as a whole. Diabetes contributes to $\$237$ billion in annual costs, which makes it the most expensive chronic disease in the U.S. So much so, that one in every four dollars spent on healthcare goes toward diabetes. Without understanding the complete cost of illness, that money can not be spent effectively to help those with diabetic amputations. Since the cost and time commitment of maintenance for diabetes is very expensive, there’s a natural relationship between low socioeconomic areas and high rates of untreated or undertreated diabetes. Consequently, these areas also face high rates of diabetic amputations; studies show that certain low-income neighborhoods have 10 times higher amputation rates compared to their high-income counterparts, as a result of lower resources, medical infrastructure, financial support, which are important factors in diabetes management and living with an amputation. Racial disparities are another factor of amputation. Black Americans are under-represented in treatments that would prevent or delay preventable limb loss and over-represented in amputation surgeries. Both economic and racial disparities together create centers of extremely high amputation rates, which is shown by geographic clustering of diabetes and amputation rates. Diabetic amputation is considered one of the most preventable chronic conditions. Studies have shown that 75 percent of diabetic amputations could have been prevented through education, earlier identification, and treatment of ulcers. Experts suggest more than 80,000 toe, foot, and lower-limb amputations could have been prevented with better diabetic control. As the prevalence of diabetes grows, it is important to document and better understand rates of diabetic amputations, how they come about, and best practices for preventing them. Most studies providing data regarding diabetic amputations are outdated and need to be updated regularly to inform policy-makers how to allocate resources for prevention. Thus, areas of work that specifically need to be highlighted are amputation prevention and health equity.