Oklahoma Sees Rise in Diabetes-Related Amputations Despite National Decrease
Oklahoma has reported a significant increase in diabetes-related amputations, contrasting with a national trend of decline, according to a recent study conducted by the University of Oklahoma.
Over the past decade, the rate of non-traumatic lower extremity amputations in the state has nearly doubled, with both major and minor procedures on the rise. Dr. Kelly Kempe, an associate professor of vascular surgery at the OU School of Community Medicine in Tulsa, led this research, which was published in the Journal of Vascular Surgery.
Dr. Kempe emphasized the troubling nature of these findings, noting that major amputations, such as leg removals, have increased significantly. Poorly managed diabetes can lead to reduced blood flow, which damages the toes, feet, or legs and raises the risk of amputation. Peripheral arterial disease, a condition often linked to diabetes, can also contribute to lower limb loss if left undiagnosed.
To assess the situation, Kempe and her team analyzed over 1.3 million anonymized discharge records of Oklahoma patients diagnosed with diabetes or peripheral arterial disease over a 12-year period. Their study revealed that out of those discharged, 15,642 individuals had undergone amputations, averaging 12 amputations per 1,000 patients. The year-over-year comparison indicated a dramatic increase in the proportion of amputations, rising from 8.1 per 1,000 in 2008 to 16.2 per 1,000 in 2019.
In contrast, the national average stands at 4.9 amputations per 1,000 adults, as reported by the Centers for Disease Control and Prevention. The study also highlighted that the highest amputation rates were observed among males, American Indians, uninsured individuals, and those aged between 45 and 49 years. Interestingly, being married appeared to have a protective effect, possibly due to the social support it provides.
Several theories have been proposed to explain the rise in amputations in Oklahoma. One significant factor is the high uninsured rate in the state, which was nearly 14% in 2021. This lack of access to quality preventive care may leave many at-risk patients without the necessary resources to manage their diabetes effectively.
Dr. Kempe pointed out that regular monitoring of blood sugar levels can help prevent amputations, but the state's healthcare access issues hinder many individuals from receiving proper care. Additionally, the study indicated that a multidisciplinary approach to healthcare, which includes access to a range of specialists, can lead to better outcomes in limb preservation. However, such integrated care systems are scarce in Oklahoma.
To address these challenges, Dr. Kempe and her colleagues initiated a pilot project aimed at training primary care providers within the Chickasaw Nation on the detection and prevention of lower limb diseases. Preliminary findings from this initiative have shown promise, and the project has since expanded to include providers from the Muscogee Creek Nation.
As healthcare professionals and policymakers strive to reduce preventable amputations in Oklahoma, there is an urgent call to implement limb preservation programs and focus interventions on at-risk populations. Increasing awareness about the dangers of unmanaged diabetes and the available solutions is seen as a crucial first step in combating this public health issue.
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