National experts and state lawmaker react to diabetes amputation increase
Dr. James Longobardi describes amputations with a model foot in his office. (Megan Wood, inewsource)

National experts and state lawmaker react to diabetes amputation increase

A state legislator who is leading an inquiry into the escalating rates of diabetes and heart disease highlighted inewsource data in his campaign to provide more money to diabetes prevention through a soda tax.

Assemblymember Richard Bloom said he was surprised by data in our story that documented skyrocketing diabetes-related amputations in California. Our analysis found the population-adjusted rate of amputations increased by 31 percent from 2010 to 2016 statewide, with a 66 percent increase in San Diego County.

The Santa Monica Democrat cited the data at a hearing on diabetes in Los Angeles last week and plans to continue asking questions at upcoming hearings in Fresno and Sacramento. These are part of the Assembly Select Committee on Diabetes and Heart Disease Prevention, convened by Bloom.

He characterizes diabetes as an epidemic because it is diagnosed in approximately 9 percent of California residents.

The amputation rate increase “did surprise me,” Bloom said of the inewsource data in a phone interview. “As a legislator, I don’t want to step out and point a finger at anyone before I have more information” about the reasons behind it. “We need more information.”

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The California Department of Public Health’s one-sentence response to inewsource concerned Bloom. When asked about the data, a spokesman for the department, which has a dedicated program for diabetes prevention, responded that it “does not have information related to possible reasons for increases in diabetes-related amputations.”

Bloom said that after his initial surprise at the data, in retrospect, growing populations of homeless and people with diabetes make the amputation rates “start to make more sense.”

In an email, he said “I am anxious to hear experts postulate why we are seeing a dramatic increase in amputations.”

inewsource data center amputations

Search each California county’s rate of amputations per 100,000 residents and how it compares to the state.

Bloom said during the interview the state’s diabetes prevention program receives no state money, which he hopes to change with revenue from soda tax legislation he has introduced. That bill has failed so far and is now on a two-year track.

“It’s pretty shocking that our funding level is as low as it is,” Bloom said.

inewsource “uncovering this information – that amputations are significantly higher than we thought – is helpful because I think it helps us get closer to the place where I think we can start funding these programs.”

Our findings prompted reactions across the country.

Dr. David Armstrong, a diabetes specialist, podiatrist and surgeon at the Keck School of Medicine at the University of Southern California, called the story a “call to action,” which is how he said various health officials and academic faculty members at UCLA and the Los Angeles Veteran’s Administration hospital reacted to the story he distributed.

Armstrong, who authors a blog for diabetes foot specialists, said his colleagues believe a partial solution to the increase in amputations is to expand the number of foot specialty clinics and podiatry services throughout the state to more rapidly detect and treat foot wounds that may otherwise go unnoticed. Too often, he said, people with diabetes-related neuropathy lack “the gift of pain” that would alert them to ulcers that then get infected.

The story prompted numerous comments from physicians and patients across the country suggesting a variety of other reasons for the increase in lower limb amputations. Among those was the theory, expressed in comments on a version of the story published by inewsource’s partner, MedPage Today, that people with diabetes don’t understand the gravity of their condition and don’t appreciate the necessity of curtailing carbohydrates to prevent progression of their disease.

The story also prompted physician comments critical of their fellow providers, saying that in the rush to see patients on daily schedules, they too frequently fail to conduct proper foot exams on their patients.

More in the series …


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Diabetes-related amputations: How we crunched the data
Sept. 20, 2017
To identify the increase in diabetes-related amputations in California, inewsource analyzed data from the California Office of Statewide Health Planning and Development, the agency that collects information about the care provided to patients discharged from California hospitals.

Physician models of feet help people with diabetes understand the impact of the disease on blood flow to their lower limbs. (Megan Wood, inewsource)
Diabetes-related amputations up significantly in California — and San Diego
Sept. 20, 2017
Clinicians are amputating more toes, legs, ankles and feet of patients with diabetes in California — and San Diego County in particular — in a “shocking” trend that has mystified diabetes experts here and across the country.

Research involving the diabetes drug Invokana shows a doubled rate of leg, foot and toe amputations in patients. (Megan Wood/inewsource)
Doctors debate danger of popular diabetes drug after FDA amputation warning
August 31, 2017
Many San Diego doctors are taking their patients off of Invokana, a widely used diabetes drug, after a large industry-sponsored trial found it doubled the risk of lower limb amputations compared with those taking a placebo.

Photo courtesy Michael Stern, Flickr Creative Commons
Medicare boosts incentives to promote weight loss, prevent diabetes
July 17, 2017
Participating providers — from hospital systems and physician groups to wellness centers, supermarket chains and even churches — could receive up to $785 for each participant who loses 5 percent of their body weight.

Diabetes drug displays lined the San Diego Convention Center hallway during June's American Diabetes Association meeting here. June 11, 2017. Cheryl Clark, inewsource.
Spending on diabetes drugs is ‘skyrocketing’
July 5, 2017
The largesse of a the drug industry related to diabetes is skyrocketing by any measure: dollar cost per unit, the number of people purchasing them and the number of prescriptions sold.

Oscar and Teri Lara shop for fresh food more frequently in their quest to lose weight and avoid diabetes. June 27, 2017. Megan Wood/inewsource
Medicare to pay $450 to help seniors lose weight, avoid diabetes
June 29, 2017
Some 86 million Americans live with prediabetes, which can progress to diabetes, a costly and debilitating disease. A new program can help people lose weight, a proven way to reduce the risk of getting the disease.
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About Cheryl Clark:

Cheryl Clark

Cheryl Clark is a senior healthcare reporter at inewsource. To contact her with questions, tips or corrections, email cherylclark@inewsource.org.