As a Diabetes Specialist at a local Native Health Services Clinic, I assess a lot of feet every day.  I believe this simple act of looking, touching, questioning, caring, and referring has saved many lower extremities.

Last month, a client arrived who was excited to report that they were able to walk for over an hour without getting short of breath. We celebrated this accomplishment and then I asked them to take off his shoes, knowing this person had already lost all of the toes on their left foot due to diabetes. The client wasn’t wearing custom shoes to accommodate this foot, just regular tennis shoes.

When the socks came off, I discovered an angry-looking ulcer that the person wasn’t too concerned about, saying, “it’s not really bothering me.”  We sent this client to the emergency department, and they were immediately started on antibiotics to stop this very dangerous infection.

That’s just one example of how the simple act of assessing feet at during a wellness visit can make a big difference in outcomes.

Lowering Amputation Rates Through Annual Wellness Visit

A study conducted by researchers at the University of Virginia School of Medicine reviewed data on the impact of Wellness Visits on amputation rates in the “Diabetes Belt”.

The “Diabetes Belt,” refers to 644 counties in the southeastern and Appalachian regions of the U.S. with higher rates of diabetes including the state of Mississippi as well as portions of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and West Virginia. 

People living in the Diabetes Belt had 27% greater odds of requiring a lower-extremity amputation compared to residents of counties surrounding the belt.

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A simple intervention with big rewards:

This ten-year study at the University of Virginia found that people with diabetes who participated in a free Annual Wellness Visit covered by Medicare were 36% less likely to need an amputation compared to those who did not attend an Annual Wellness Visit regardless of where they lived.

“Our results confirmed our hypothesis that Annual Wellness Visits are associated with a reduced risk of major lower-extremity amputations, highlighting the importance of connecting patients to preventive care services,” said Jennifer Lobo, PhD, a researcher in UVA’s Department of Public Health Sciences.

Racial Disparities associated with increased amputation risk

The research also revealed significantly higher rates of diabetes-related amputations among Black participants compared with non-Hispanic White participants, both inside and outside the Diabetes Belt.

Based on these research results, more resources and changes in our health care system are needed to decrease amputation rates in the Diabetes Belt. As health care providers, we can take an active role in reaching out to Black community members to determine systemic barriers. Then, through community collaboration, we can start building bridges to improve inclusivity and access to healthcare.

To learn more about addressing racial disparities to reduce amputation, click here and click here.

Value of Preventive Foot Care

The researchers concluded that people with diabetes who participated in their Annual Medicare Wellness Visit may have had their foot complications diagnosed sooner, helping prevent amputations. Also, given the effectiveness of wellness visits to prevent future problems, the authors suggest incentivizing people with Medicare to use their annual wellness visits to evaluate lower extremities and provide education and foot care training.