medwireNews: People with diabetes who attend an annual wellness check are significantly less likely to require a major lower extremity amputation within the same year, shows research from the US Diabetes Belt.
The research was based on Medicare beneficiaries, who are entitled to a free annual healthcare check, and found a 36% reduced odds for amputation among people who attended their check-up.
These associations were independent of demographic factors including age, sex, and race/ethnicity, as well as comorbidities, amputation risk factors, and access to care.
Jennifer Lobo (University of Virginia, Charlottesville, USA), who presented the findings at the 82nd ADA Scientific Sessions in New Orleans, Louisiana, suggested that people who made use of the annual wellness checks had diabetic foot issues diagnosed earlier than those who did not.
“We feel that policymakers should prioritize incentives for having patients participate in annual wellness visits to help improve preventive care and reduce major lower extremity amputations, particularly in the Diabetes Belt,” she said.
The study cohort involved over a million Medicare beneficiaries with diabetes who were resident in the Diabetes Belt, which comprises 644 counties in Southeastern and Appalachian USA. The researchers compared these people with a similar number from 118 surrounding counties.
The study participants were around 75 years old, on average, 45% were men, and about three-quarters were non-Hispanic White overall but there was a higher proportion of non-Hispanic Black people in the Diabetes Belt than surrounding areas (22.7 vs15.0%).
People in the Diabetes Belt had a significantly lower rate of diagnosed foot ulcers than people in surrounding countries (87 vs 92 per 1000 people), and the same was true for osteomyelitis (nine vs 10 per 1000), and peripheral vascular disease (171 vs 204 per 1000).
Lobo said these differences “may suggest that delayed diagnosis of foot complications is happening [in the Diabetes Belt] and can lead to major lower extremity amputations.”
Conversely, people in the Diabetes Belt were using a significantly greater number of glucose- and lipid-lowering medications than those from surrounding counties.
People in the Diabetes Belt had a 27% increased risk for requiring a major lower extremity amputation, compared with those in the surrounding counties. This was in line with previous research from the team, which found approximately one additional major lower extremity amputation per 1000 people in the Diabetes Belt compared with the surrounding counties.
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ADA Scientific Sessions; New Orleans, Louisiana: 3–7 June 2022