Tying Income to Diabetes Amputation

Diabetes and poverty raised risk for loss of limbs in new study

/ Author:  / Reviewed by: Dominique Brooks, M.D Beth Bolt, RPh

(RxWiki News) People with low incomes and diabetes sometimes have worse disease-related outcomes than those with more resources. Losing a limb from diabetes complications may be one of those outcomes.

Researchers compared Californians in high-poverty neighborhoods to those in communities with more earnings. They found that amputations were higher among poorer people with diabetes.

"Ask your nephrologist about avoiding diabetes complications."

"People in poorer communities operate according to Gresham's law that states that the less disposable income you have, the more of it goes to food," said Dr. Barry Sears, President of the non-profit Inflammation Research Foundation in Marblehead, MA and creator of The Zone Diet. "This means that cheap foods rich in refined carbohydrates and omega-6 fatty acids are more likely to be larger factors in their diet. This [may] increase diet-induced inflammation caused by refined carbohydrates and omega-6 fatty acids [which] drives insulin resistance eventually moving toward metabolic syndrome and type 2 diabetes at faster rates."

According to Dr. Sears, "Amputations are a consequence of diabetic neuropathy, which is usually detected early by comprehensive medical exams. Access to comprehensive prevention health care is another commodity in short supply in poorer communities."

This study was led by Carl Stevens, MD, a professor at the University of California at Los Angeles David Geffen Medical School.

This investigation relied on 2009 data from the UCLA Center for Health Policy Research's California Health Interview Survey — which estimated where diseases were concentrated by zip code. The research team reviewed California’s Office of Statewide Health Planning and Development information on amputees who had been discharged from hospitals. They also reviewed US Census Bureau data on income in the state.

Using that data, the study authors counted 6,828 diabetes patients 45 or older who had a toe, foot or leg amputated due to the disease.

Diabetes is a disease marked by the body's inability to regulate blood sugar.

The authors concluded that people living in the poorest rural and urban zip codes were 10 times more likely to have an amputation than people who lived above the poverty line. The study considered rural residents but mainly focused on residents of Los Angeles, Sacramento, San Diego and San Francisco.

Those aged 45 and older faced a higher risk of a diabetes-related amputations than younger people, researchers wrote.

"I've stood at the bedsides of diabetic patients and listened to the surgical residents say, 'We have to cut your foot off to save your life,'" Dr. Stevens said in a press release. "These patients are often the family breadwinners and parents of young children — people with many productive years ahead of them."

The authors of this study also wrote that a person’s access to quality care may factor into the likelihood of amputation.

Without proper care, diabetes can weaken the immune system. What seems like a simple blister or other foot injury can result in an infection that may require amputation, the researchers said.

Of the 6,828 patients in the study, 1,000 of them had two or more amputations.

The study was published online Aug. 4 in Health Affairs.

The Korein Foundation, National Center for Advancing Translational Science and UCLA Clinical and Translational Science Institute funded the study. The authors disclosed no conflicts of interest.

Review Date: 
August 4, 2014
Last Updated:
August 8, 2014