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The Importance of Early Diabetes Awareness

4/11/2019

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By: Maddie Barbe

As a third year podiatric medical student, I have already seen my fair share of patients who have lost parts of their limbs to varying degrees. There are an estimated 1.9 million Americans living with amputations at any given time, with about half being non-white. Often times, those patients who have undergone amputations seem the most educated about managing the diabetes and its sequelae. But it is imperative that diabetes management awareness take place early with diagnosed patients. So, how can we reach patients earlier to educate them on diabetic amputations?


  • Numbers: an estimated 68,000 Americans undergo amputations within a year, with a significant share of those being related to diabetes and peripheral vascular disease.
  • Prognosis: once undergoing an amputation, there is a high 5 year mortality rate, estimated as high as 50%.
  • Symptoms to watch out for: In a study by Reiber (1994), she found that patients who had undergone amputations at VA Hospitals had previously experienced numbness (57%), lack of pain (42.5%), claudication (62.3%), ulceration (84%).
  • How to decrease risks: emphasize returning for routine diabetic foot assessment, using diabetic shoes if they qualify, wearing shoes around the home, checking their feet every day out of the shower for calluses or pre ulcerations, sugar control, smoking cessation…
  • Sequelae: risks for cardiovascular disease, obesity, joint issues, depression, need for more proximal or contralateral amputation goes up once a patient has undergone one amputation.
  • Share some good news: amputations peaked at 185,000 per year in 1996. Diabetic amputations have since dropped 67% through prevention efforts and medical management. So, having diabetes with those additional risk factors is not a death sentence. If the patients take steps to decrease risk and see doctors when possible, they can dramatically decrease chances of undergoing amputation.

    It is worth spending extra time with diabetic patients, especially those with additional risk factors, about the risks of amputation and how they can help prevent them.

Numbers and data from Amputee Coalition’s Roadmap to Preventing Limb Loss in America.

About the Author: Maddie Barbe is a member of the Class of 2020 at Temple University School of Podiatric Medicine. She serves as Director of Outreach with FootAid.

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Medical Malpractice Concerns

For those providers who are forced to face malpractice concerns in their practice in the United states a few things should be understood:
  1. “No malpractice claim has ever been filed against any American health care worker providing humanitarian services without charge in the developing world.”(1) The malpractice risk is almost nonexistent as long as the practice is limited to the indigenous population and that care is provided free or at minimal charge.
  2. The only documented malpractice against american physicians in the developing world is the care of “western” patients in “for profit” health centers and hospitals.
  3. There is a small civil liability noted in the developing world. This only involves traffic accidents and accidental injury and death when American health care workers are involved in an incident in a non-medical capacity.
  4. In 2003 a study was done that found that not one volunteer or missionary agency provides malpractice insurance, as coverage of this type in simply not available.
“To summarize, Americans travel and carry their malpractice mentality with them even though malpractice is not an issue in the country where they are traveling. The malpractice liability is in providing care for Americans traveling or living overseas, and charging for those services. There appears to be minimal to no risk in providing free medical care to the indigenous population in poor countries while doing “voluntary” or “humanitarian” service.” (1)
​

1. W. “Ted” Kuhn: Medical Malpractice in the Developing World. Global Medical Missions, Winepress Publishing, 2007 
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