The American Diabetes Association’s Role in Preventing Amputations

During a Town Hall session at ISET 2022 focused on racial disparities in amputations, Stephanie Silverman, board member of the American Diabetes Association (ADA), spoke to attendees about the role that the ADA has taken in helping prevent amputations among people with diabetes. Every four minutes in America, a limb is amputated due to diabetes—a rate that has increased by 75% since 2014. Approximately 60% or more of nontraumatic, lower limb amputations occur in people with diabetes. And 85% of diabetes-related amputations are preventable.

The racial disparities of people with diabetes is well-known. African Americans are over 50% more likely to have diabetes than non-Hispanic whites; 12.5% of Hispanic/Latino adults in the United States have diagnosed diabetes; and 11.7% of non-Hispanic black adults have diagnosed diabetes.“In late 2020, after the horrible moments that the country witnessed with George Floyd and the devolution of the country into a pandemic, the ADA issued its Health Equity Bill of Rights,” Silverman said. This Bill of Rights lists the 10 rights to which the ADA believes every person with diabetes is entitled, and number 5 is the right for people with diabetes to avoid preventable amputations. “It's obvious that we have an outsized challenge in communities of color,” she added.

Regarding social determinants of health, Silverman said, “We've seen a lot of studies about how diabetes and amputation rates increase precipitously, depending on geography. In just one California survey, when you look at Malibu and Beverly Hills, you see that 1.5 people with diabetes per 1,000 lose a limb to diabetes, whereas almost 11 people out of 1,000 in areas like Compton do. What we're seeing is a pandemic within a pandemic. The ADA is committed to making this a priority, both in our engagements with healthcare providers and with policy leaders and the public at large.”

Silverman identified 3 areas that need to be addressed by the ADA in partnership with physicians: access to care, knowledge gaps, and the need for more data. “We've heard about how challenged many patients are to get access to care, particularly in rural or underserved urban areas,” she said. “But in the diabetes universe, more than 90% of people with diabetes are treated not by a specialist but by a primary care provider, which is one of those unique challenges to the diabetes population—that primary care providers don't have the training, the tools, or the resources to be able to know how to properly treat these patients.” Too many primary care providers don't know where to send their patients and don't know how to properly care for them when they show critical limb ischemia (CLI). The ADA is focused on helping them.

Silverman emphasized the importance of educating people with diabetes about CLI, a term that many physicians know but most patients do not. The ADA is working on a major initiative to promote public awareness and identify the terminology that will resonate with patients and health care providers.

“The ADA is excited to be part of this conversation,” Silverman concluded.