When I started working in Academic Family Medicine, it became clear that chronic illness care (care for diseases such as hypertension and diabetes) was what we should do well. We reorganized our entire practice to assure that our diabetic patients were getting measurably better care. This reorganization was in 1996. In the interim we have seen the development and promulgation of the Chronic Care Model, the Triple Aim, the Patient Centered Medical Home, and other catchily named initiatives to try and encourage docs to delivery more effective care for patients with chronic conditions such as diabetes. Guess what…THERE IS EVIDENCE THAT IT IS WORKING and I missed it. From the CDC:

The rate of leg and foot amputations among U.S. adults aged 40 and older with diagnosed diabetes declined by 65 percent between 1996 and 2008, according to a study by the Centers for Disease Control and Prevention and published today in the journal, Diabetes Care.  The age–adjusted rate of nontraumatic lower–limb amputations was 3.9 per 1,000 people with diagnosed diabetes in 2008 compared to 11.2 per 1,000 in 1996.  Non–traumatic lower–limb amputations refer to those caused by circulatory problems that are a common complication among people with diabetes rather than amputations caused by injuries.

Why is this?

The study authors note that improvements in blood sugar control, foot care and diabetes management, along with declines in cardiovascular disease, are likely to have contributed to the decline in leg and foot amputations among people with diagnosed diabetes.

Why am I hearing about this only now??? This is the tough work that Family Physicians do, caring every day for people with diabetes and other chronic illnesses. There is still work to do. The rate of amputations is still 8 times higher than the general population and the rate of amputations among African Americans is much higher than whites, likely due to inadequate access. However, there should be dancing in the streets. For many, that dancing is on both feet, thanks to more effective diabetes care.

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