Diabetes has been around since ancient times.  In the United States, there are currently 18.8 million people diagnosed with diabetes, and it is presumed that there are an additional seven million people undiagnosed.  

Diabetes has been directly linked to other chronic morbid diseases such as heart disease, vascular disease, kidney disease, etc. Even though the death rate for some of these diseases have declined in recent years, the mortality rates for diabetes continues to increase and are even higher for people with diabetic ulcers. In fact, people with diabetic ulcers have a five-year mortality rate of 46 percent which is more than double the mortality rates of malignancies such as Hodgkin’s disease and breast cancer.

 These alarming figures have caused a national movement to change the marketing strategy for diabetes and create awareness of the complications caused by this condition that can be life threatening.  In an effort to do this, it has been proposed to change diabetes from just a chronic disease to a “malignancy” as it is a condition that can cascade into life-threatening symptoms, such as nephropathy, neuropathy, vascular problems, ulcers, limb loss, etc.  Thus a multidisciplinary approach is important for the control of diabetes as well as such complications. Even though the foot salvage rates have improved in the United States, diabetics still account for more than 50 percent of the amputations in this country and 50percent of these people will undergo further amputations of the same or contra lateral limb within five years. The ADA estimates that approximately 50 percent of all diabetic foot amputations are preventable. Foot-care programs, which focus on identifying risk factors for the development diabetic ulcers and ultimately amputations, have shown to reduce the rates of ulcer and amputations by as much as 85 percent. Following is an example of the importance of a multidisciplinary approach as well as patient compliance and awareness.

A 56-year-old uncontrolled diabetic male presented to the podiatrist with severe infected ingrown toenail unresponsive to oral antibiotic with drainage and cellulitis. The patient had a history of severe vascular disease in need of revascularization surgery which could not be performed due extremely elevated Hemoglobin A1c of 13 percent. Despite awareness created by the vascular surgeon, the patient did not follow up with PCP as he “felt okay” and did not think it was a “big deal.” On his first visit to the podiatrist, the ingrown toenail had to be removed in order to allow the infection to drain. The patient was also admitted to the hospital for IV antibiotics and further testing, which not only revealed an abnormal CBC but the patient was also on renal failure and had a Hemoglobin A1c of 16 percent.  A team of internal medicine, endocrinology, vascular, podiatry, and renal was put together to treat multiple problems.

The patient’s toe developed color changes and vascular status continued to deteriorate but surgery could not be performed still due to uncontrolled diabetes and post op complications associated with this. Eventually he developed wet gangrene thus toe had to be emergently amputated.  As expected, the surgical site dehisced.  The team worked together to treat uncontrolled diabetes and renal status in order to stabilize the patient for surgery.

The patient eventually had the bypass, but the graft failed, and the patient ultimately had a BKA. This demonstrates the importance of a multidisciplinary approach for diabetes and the measures that need to be taken to change the patient’s perspective on the condition. This non-compliance and lack of care from the patient show how much changing the marketing strategy and approach for diabetes could make.  Not only in the length, but the quality of life in the diabetic patient.

Dr. Alvarez currently practices at Wolf River Family Footcare in Bartlett and Millington. She graduated from the Ohio College of Podiatric Medicine in Cleveland, Ohio and completed a 3 year podiatric surgery residency at the Louis Stokes Cleveland VA Medical Center in Cleveland, Ohio.

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