Amputation risk is increased for diabetics living in low-income areas: study
“What we need to address as a healthcare system is this unequal access to screening,” Woods said.
More than 7,000 people with diabetes undergo amputations of their legs, feet, or toes each year in Canada, and most of these procedures could have been avoided, according to a report released by the Canadian Institute for Health Information (CIHI) on Thursday.
The report revealed that individuals with diabetes living in low-income neighborhoods are three times more likely to require an amputation compared to those in higher-income areas.
Additionally, people in remote regions face a greater risk than those in urban centers.
“Our report focuses on leg amputations that occur annually as a complication related to diabetes,” said Erin Pichora, CIHI’s program lead for population health, in an interview. “We’re examining these because, for the most part, they are preventable.”
A lack of access to primary care, which helps manage diabetes, is one key factor contributing to these disparities, Pichora explained. Furthermore, unequal access to specialists like podiatrists and chiropodists, who treat diabetic foot wounds before they become severe, likely plays a role.
Diabetes Canada emphasized the need for equitable access to care, pointing to the emotional and financial strain faced by individuals who undergo amputations.
“People living with diabetes who experience amputations endure significant emotional and financial distress,” said Laura O’Driscoll, senior policy manager at Diabetes Canada, in a statement. “We must ensure that everyone with diabetes has affordable, timely access to medications, devices, education, and care to manage their condition and prevent complications like amputations.”
CIHI researchers analyzed hospital data across Canada for fiscal years 2020-2021 and 2022-2023, identifying approximately 7,720 lower limb amputations annually in patients aged 18 and older. Of these, about 3,080 hospitalizations involved above-the-ankle leg amputations, while 4,640 were for amputations below the ankle, including feet and toes.
Dr. Charles de Mestral, a vascular surgeon and consultant on the report, explained that people with diabetes are at risk of amputations due to two factors.
The first is nerve damage, which prevents patients from feeling wounds on their feet, allowing injuries to worsen untreated. The second is poor circulation caused by peripheral artery disease, which can inhibit healing.
“Nothing heals without proper blood flow,” de Mestral noted. While he is often able to restore blood flow through surgery and prevent amputations, he also encounters cases of severe infections or debilitating pain where amputation becomes the only solution.
Dr. de Mestral stressed that the key to preventing amputations is avoiding foot wounds in the first place, which can be as simple as wearing the correct footwear or having calluses removed. He advised people with diabetes to check their feet daily and seek medical attention if they notice any wounds developing.
Due to the inequitable access to primary care and specialists like chiropodists, podiatrists, and wound care nurses, Dr. Nicole Woods is exploring alternative methods to ensure regular foot screening for people with diabetes.
Woods, the director of the Institute for Education Research at the University Health Network in Toronto, said that an estimated 80 percent of lower limb amputations could be prevented with proper screening.
“What we need to address as a healthcare system is this unequal access to screening,” Woods said.
Through a project funded by Diabetes Canada, Woods and her team are working to train non-medical personnel, including personal support workers, family members, and shelter staff, to conduct foot screenings for people with diabetes.
“It’s really just about spotting an early wound—something that needs to be examined—and recognizing it sooner,” she explained. “This is something we can do for each other and for ourselves.”
