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People with diabetes often use a blood glucose monitoring device to help them maintain healthy glucose levels. / Centers for Disease Control and Prevention

Risk of life and limb is not just a metaphor for low-income diabetics.

A UCLA study published Monday found that people with diabetes in low-income neighborhoods are 10 times more likely than diabetics from wealthy neighborhoods to get their limbs amputated because of a diabetes-related infection.

The study, published in the August issue of Health Affairs, found that California neighborhoods with high amputation rates had a greater concentration of households below the federal poverty level. Amputation patients were most likely to be minorities, non-English speaking, male and older than 65, researchers said.

"Neighborhoods where highest rates were seen tend to be where first-generation immigrants lived as their first neighborhood," said Carl Stevens, lead author of the study and a clinical professor of medicine at the David Geffen School of Medicine at UCLA.

These amputations could be prevented with earlier diagnosis and treatment of diabetes, the researchers said. People who don't properly manage their diabetes can lower their immunity to bacterial infections. This, combined with numbed nerves in the feet due to reduced blood circulation, can result in a blister or cut on the foot turning into a life-threatening infection. In this case, amputations are the last and only resort, said Ann Albright, the director for the diabetes division at the Centers for Disease Control and Prevention.

"Patients that don't have adequate care will put off seeking care until their foot is red, swollen and obviously infected," Stevens said. "They'll go to the emergency room, where they find the infection is too far and often need amputation beginning at the toe to further up the leg."

Many factors contribute to the high amputation rates in those neighborhoods, Stevens said, including poor health literacy and education and inadequate access to primary care. Diabetic patients need a full team of medical practitioners to optimally care for them, including a primary care physician, a nutritionist and pharmacist. This level of access is often unavailable or difficult for low-income patients.

Those with lower levels of income and education "tend to have greater behavioral risk factors, including hypertension, smoking, less education about health, lack of access to medical care, lack of transportation and cost of care," Albright said.

The data were pulled from Census numbers and hospital discharge statistics from 2009, as well as the UCLA Center for Health Policy Research's California Health Interview Survey, which estimated the prevalence of diabetes in low-income areas. Stevens said this study was conducted before the Affordable Care Act was implemented in California, so he would expect results today to be different.

"The impact of the Affordable Care Act will be positive and will be substantial but will be limited by the number of primary care physicians in urban areas," Stevens said.

The shortage of primary care doctors in urban low-income areas is one of the factors behind poor health education in those neighborhoods, Stevens said. More than 29 million Americans were reported to have diabetes in 2014, and about one-fourth of diabetics do not know they have it, according to the CDC.

Diabetes is the leading cause of non-traumatic lower limb amputations, and 60% of those amputations occur among diagnosed diabetics, Albright said.

"Many low-income workers are required to spend a lot of time on their feet," Stevens said. "Particularly if a main wage-earner is having this complication, it's devastating to the family."



Copyright 2014USAToday

Read the original story: Poor people with diabetes more likely to lose a limb

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