Diabetes: Taking steps to prevent amputation
The Preservation Amputation Care and Treatment (PACT) program in Nashville decreased amputation rates by 40% in patients with diabetes. Here’s how they did it.
Clinicians who treat the lower extremity know that of all the pathology that can affect it, few medical problems present more challenge, are more complex, cause more damage and result in wounds more difficult to heal than those caused by the co-morbidities of diabetes. Chronically elevated blood glucose levels are responsible for the processes that impair the neurological, vascular, and immune systems, which can result in a variety of medical problems to the lower extremity of the patient with diabetes.
When it comes to the foot and leg, we know with almost 100% certainty how they will be affected by diabetes. Diabetic neuropathy and its three subcategories — autonomic neuropathy, sensory neuropathy and motor neuropathy — can leave the lower extremity vulnerable to silent or painless trauma. That is the triggering event that can ultimately lead to lower extremity amputation. A compromised circulatory system fails to bring enough fresh oxygenated blood, nutrients, and antibiotics to a traumatic wound, and the immune system cannot resolve an infection by fighting bacteria and cleansing the wound site on a cellular level.
The results are tragic. In the United States, infected foot ulcers are the most frequent admitting diagnosis for hospitalization of patients with diabetes. In 2003, there were about 111,000 hospital discharges for lower extremity ulcers.1 There are more than 90,000 lower extremity amputation proc Continue reading