Patients on Optimal Medical Therapy Have 1/3 as Many Amputations as Patients in Usual Care

Within 13 years, out of 80 patients with type 2 diabetes and small amounts of protein in their urine, 33 patients receiving usual care had had an amputation. Only 11 patients on optimal medical therapy (OMT) had an amputation within that same time period. This is a very important problem and there are huge disparities in care. If you are an African-American with diabetes, you are 4 times as likely to have an amputation compared with someone who is white. 230 Americans a day have an amputation and 85% are related to a diabetic foot ulcer. Patients with diabetes who experience an amputation have microvascular disease and nerve damage. 70% are dead in 5 years. A diabetic foot ulcer is a lethal diagnosis that suggests the presence of diffuse small vessel disease.

Multidisciplinary teams including podiatry, vascular surgery, and medical management support are necessary to prevent ampulation. These teams lower the risk of amputation by a third, but OMT lowers the risk three fold. This is an ideal place for interprofessional collaboration and more effective patient engagement. When a podiatrist detects signs of poor blood flow or nerve damage, that is a time to help the patient understand how critical OMT is to avoid amputations and other diabetic complications. Likewise, the primary care team can engage the podiatrist at the first sign of foot problems.

If a patient has microvascular disease in the foot, it is also likely that it exists in the kidney, heart, and eye. Those problems are all related and OMT slows the development of complications in each of these organs. Many small communities and rural counties can’t support the multidisciplinary team, but they can support a primary care provider delivering OMT for cardiovascular and related conditions like diabetes and leg artery disease. That is the biggest bang for the buck! Get in touch if you want to get started. wbestermann@congruityhealth.com