The diagnosis of diabetes does not necessarily portend future complications. Type 1 diabetes accounts for approximately 5% of all cases and is not preventable. However, Type 2 diabetes (95%) is associated with decreased physical activity, obesity, advancing age and family history. Exercise, diet modification, weight loss, glucose monitoring and medication are all mitigating factors. For at risk diabetics there are six identifiable steps leading to the loss of a limb: neuropathy (loss of sensation), vascular disease, ulceration, infection, gangrene and amputation.
A Need for Treatment
A person with diabetes and one lower extremity amputation has a 50% chance of developing a limb-threatening condition on the other limb within two years, and the five year mortality rate after diabetes-related lower extremity amputation is nearly 50%. This mortality rate is higher than many types of cancers. Lower extremity amputation results in disability and loss of independence making it often more costly than limb salvage.
Complications of Diabetes
According to the Centers for Disease Control and Prevention and the World Health Organization, diabetes is the sixth leading cause of death in the United States and the World. Diabetes is associated with comorbid conditions both macrovascular (stroke, heart attack, peripheral arterial disease) and microvascular (nephropathy, neuropathy, and retinopathy). The CDC estimates that there are over 30.3 million people in the United States with diabetes mellitus and 425 million people worldwide. Approximately 60 to 70 percent suffer some sort of neuropathy, which is a leading risk factor for lower extremity amputation. Annually in the United States there are over 82,000 non-traumatic amputations related to diabetes with the annual global total exceeding one million.
The World Health Organization and the International Diabetes Foundation have stated that up to 85 percent of diabetic lower extremity amputations are preventable. Research estimates indicate that faulty wound healing and cutaneous foot ulcerations are contributing factors in 75 percent of these amputations.