Amputation Prevention Reduces Diabetes Healthcare Spending

October 11, 2022 - According to the American Podiatric Medical Association, each year diabetes care costs greater than $245 billion each year. This healthcare spending is associated with medication and emergency care. The American Diabetes Association believes that amputation prevention can reduce diabetes healthcare spending.

On September 22, 2022, the ADA announced its new Amputation Prevention Alliance initiative. This initiative’s goal is to reduce the number of preventable amputations that arise from unmanaged — or poorly managed — diabetes. Robert A. Gabbay, MD, PhD, FACP, the Chief Scientific and Medical Officer for the American Diabetes Association (ADA), sat down with LifeScienceIntelligence to discuss the alliance, its goals, benefits, and methods. 

Overview of Alliance

“It is a three-year public health initiative that is focused on reducing amputations, with a particular focus on the minority community,” began Gabbay.

To provide some context, Gabbay shared that Black communities have rates of amputation that are approximately 3–4 times higher than White communities. “Latino and Indigenous communities also face higher amputation rates than White Americans. Clinicians also know that low-income neighborhoods have a ten times greater risk of amputation,” he added.

Throughout the conversation, Gabbay continued to emphasize that the vast majority of these amputations are preventable.

These discrepancies are well understood and supported by research and statistics. ”The issue has been lack of awareness. There hasn't been a concerted effort to tackle this issue until now. There has been piecemeal activity,” Gabbay noted. “One of the things the ADA is excited about in the Amputation Prevention Alliance is that we're bringing together multiple partners.”

Funding for the Alliance

For the alliance to be successful, additional support beyond the ADA is necessary. Gabbay shared that the ADA has multiple partners collaborating on this alliance. “The ADA has several partners within the alliance, and their support has been critical. A founding partner is Podimetrics — a Boston-based company focused on preventing unnecessary amputations. And we have other partners like Abbott Cardiovascular Systems Incorporated and the CLI Global Society, the organization that's been working on critical limb ischemia (CLI),” said Gabbay.

Collaboration

Beyond collaboration from organizations, this concerted effort of this alliance provides a unique approach to tackling the issue of preventable amputation. To develop the concerted effort, Gabbay shared that the ADA “went on a listening tour around the country and convened several round tables to bring the different players together. And we were gratified to see the enthusiasm of people wanting to work on this. And so, we're excited to bring our leadership to the issue and push forward.”

The Approach

Understanding the issue and how to address it is not the same as a practical approach. LifeScienceIntelligence asked Gabbay how the ADA planned to implement methods and reach the communities most affected by preventable amputations.

Advocacy

“It's reaching out to those communities,” he responded. “The effort is multi-pronged. One component is focused on people with diabetes, raising their awareness and raising the awareness of advocacy — both at the state and the federal level. Amputation prevention is a health equity issue that's not on enough people's radar.”

Empowerment and Awareness

In addition to working with advocacy groups, the ADA hopes to collaborate directly with the communities impacted by preventable amputation. Gabbay told LifeScienceIntelligence that the ADA will “be working with community organizations and engaging them in a variety of different ways.”

The goal of working directly with communities goes beyond engaging patients. Based on Gabbay’s remarks, the Amputation Prevention Alliance hopes to empower patients.

“Many cases, even at the last stage where there’s an ulcer, where providers are saying, ‘we're just going to have to amputate,’ are preventable. If those people got a second opinion, many limbs could be saved. This alliance empowers people to say, ‘I want a second opinion. I want to make sure I do need this amputation,’” revealed Gabbay.

In addition to empowering patients to advocate for themselves, the Amputation Prevention Alliance hopes to make all providers aware of this. “While the healthcare industry has all this work focused on people with diabetes, the ADA is also looking at the people that provide care to them — particularly primary care, but other specialists as well. It is important to make providers aware that there are preventative measures and interventions that can happen even at the very late stages of disease that can salvage a limb,” stated Gabbay.

Education and Quality Measures

Gabbay shared that providers and healthcare professionals will be heavily involved in the goal of this alliance. “One way is through direct education, whether that's the training of providers or providing materials. The other effort the alliance is undertaking is to establish new national quality metrics that can lead to amputation prevention. We're working to develop those and have them implemented. We want to recognize those that are doing a great job and, in a sense, incentivize those that need to improve,” he asserted.

Longevity of the Initiative

These quality measures and metrics will allow the alliance’s effects to last beyond the intended three-year duration. Gabbay shared that the quality metrics should be longstanding and implemented nationally.

“Another prong here is around advocacy. Advocacy for better coverage of amputation prevention care will be critical for a long-lasting impact. The alliance hopes that by raising the profile of this issue and working with several partners, we can keep the radar on this issue once people start becoming aware of how big a problem it is and how preventable it is,” he expanded.

Fiscal and Patient Benefits

LifeScienceIntelligence hoped to determine what savings potentials arise from an alliance like this. “The savings come from better care and better outcomes. And so, amputations and related care are quite expensive. Preventing amputations obviously could save on that front,” added Gabbay.

According to the American Podiatric Medical Association, the average amputation costs more than $70,000. In 2013 alone, approximately 73,000 people in the United States required a diabetes-related amputation. Prevention initiatives could have yielded significant savings.

Additionally, Gabbay notes that “the outcomes of people after an amputation are quite dramatic, including mortality that rivals many cancers. Half the people that have had an amputation will die within five years. And so again, all sorts of unnecessary costs are associated with foot ulcers and ultimately amputations.”

LifeScienceIntelligence asked why this was the case, to which Gabbay responded, saying, “healthcare professionals do not fully understand this, but often it is the beginning of a downward spiral, sadly.”

“There are all sorts of mental health implications associated with an amputation. It is a major disruptor in patients’ lives. Their lack of mobility, particularly initially, makes them susceptible to other complications. In addition, much of the risk of amputation relates to peripheral arterial disease that appears as a non-healing ulcer, which leads to amputation, but that same arterial disease is happening around the heart and elsewhere,” Gabbay explained. “And so, the mortality also relates to their other diseases. The same process that led to PAD is leading to other issues for them.”

Overall, the potentials of this alliance are diverse. Throughout the three-year progression, the ADA will monitor how the alliance’s efforts have impacted diabetic amputation rates and diabetes care.