HEALTH ALLIES
Challenges for Minority
Populations In Managing
Diabetic Foot Ulcers
DIABETES IS AN EPIDEMIC
IN THE UNITED STATES.
The problem has become so large
that it is estimated to occur in 30.3M
people or 9.4% of the US population;
and 84.1M people currently are
pre-diabetic. The economic burden
associated with this disease has skyrocketed
to the tune of $237B a year
in medical costs and $90B a year in
lost productivity.1
The impact of diabetes in minority
populations is even more alarming in
the United States. The prevalence of
diagnosed diabetes is greater among
those with less than a high school
education. This number becomes
incrementally smaller when higher
levels of education are obtained.1
But the reason minority communities
should be especially concerned is
because the overall prevalence of
diabetes is highest among them.
Although anyone can develop a
diabetic foot ulcer, Native Americans,
Hispanics and African Americans are
more likely to develop them.1
In the US, diabetes is the leading
cause of non-traumatic amputations
which is most often preceded by
a diabetic foot ulcer (DFU). Sixty
percent of diabetic lower extremity
amputations are preceded by a
DFU.2 Having diabetic peripheral
neuropathy places these individuals
at high risk for non-healing ulcers.
Not just because of the loss of
6 Dallas Medical Journal April 2019
protective sensation which helps in
avoidance of re-injury but because
of the underlying pathophysiology of
a faulty healing mechanism, they are
at an increased risk for loss of limb.3
These DFUs manifest with a chronic
inflammation pattern which has
been detected within 3 days of initial
onset. This pattern of healing is not
seen in non-diabetic acute wounds
of the foot. Poor glycemic control,
repetitive trauma with exposure to
micro-organisms in an open wound
due to neuropathy and small vessel
arterial disease leads to impaired
healing which leads to infection and
tissue death.3 Because the diabetic
host has a poor immune response,
he is at increased risk for sepsis and
death, often making an amputation a
medical emergency.
LESSENING THE LIKELIHOOD
OF A DFU
Since minority populations have a
higher incidence of diabetes, it is
important to know who is at risk
for diabetes within that subset.
Questionnaires on symptoms related
to diabetes, family history, personal
activity patterns and current weight,
along with checks for blood glucose
and hemoglobin A1C levels, can help
detect those who are prediabetic or
who may already have diabetes. One
quick resource for patients can be
found at www.doihaveprediabetes.org to
determine if they are at risk for prediabetes.
4
Here is the good news: it is
possible to reverse prediabetes with
small steps and these measures can
help individuals live a longer and
healthier life. Programs are available
for prediabetics who, with education,
can make adjustments in lifestyle
to help prevent full development of
diabetes.4
The best thing to do for those who
are high risk for the disease is to
contact their physician to determine
if any additional testing is needed.
Those who are newly diagnosed
with diabetes should seek the
advice of their physician and, with
the detection of neuropathy, should
follow-up with a podiatrist and be
encouraged to perform daily foot
checks.
DEALING WITH
A DIABETIC FOOT ULCER?
Because of the increased risk
for amputation, immediate care
should be sought. DON’T DELAY
REFERRAL to a qualified wound
care provider! Time is of the essence
to save a limb and a life. Access to
timely care often is a challenge in
minority communities because of
healthcare disparities. Sometimes
this population’s care falls through
the cracks in medicine. These
patients should be referred to a
by Maxine Theriot, MD