New Research Finds That Your Race and Region Impact Your Risk of Diabetes-Related Amputation

Amputations stemming from diabetes are a serious side effect for people living with the disease. Amputations can become necessary due to nerve damage, or neuropathy, and poor circulation. When a patient can’t feel their feet, they may be unaware of minor foot injuries that become much worse. Poor circulation can then make it difficult for the injury to heal. A new study finds that your odds of needing an amputation in these situations may be higher based on your race and where you live.

A team of researchers from Texas A&M University examined numbers from the Nationwide Inpatient Sample, which provides information on 35 million hospital stays every year. When they looked at diabetes-related hospitalizations, they found that people in rural areas and certain racial groups are seeing an increase in amputations. The study can be found in Diabetes Care, the American Diabetes Association’s journal.


To conduct their research, the team looked at the demographics of those who had minor lower extremity amputations (LEAs), meaning they had a foot or a toe removed, and major lower extremity amputations, which involves removing at least some of the leg. The team factored in age, gender, and health of the patient as part of their analysis.

Researchers found that the rate of minor LEAs increased between 2009 and 2017, most notably in rural residents, patients in the West, and Native American, Asian American, and Pacific Islander populations.

When it comes to major LEAs, rates remained roughly the same. However, there were increases in the Midwest, rural areas, and in white populations. Researchers also say that while Black people were less apt to have a minor LEA, they were more likely to have a major LEA than white people. In addition, the research found that those who live in the South or in rural areas had the greatest chances of needing a major amputation, with urban areas and the Northeast faring better.


The overall flat rate of major amputations was a bright spot for researchers, though.

Dr. Marvellous Akinlotan, study author and research assistant professor at Texas A&M University College of Nursing, says, “The good news is the major-to-minor amputation ratio is dropping, which means there are fewer major amputations being conducted and more minor amputations. Even though an amputation of any kind can be devastating, that ratio is dropping and that shows that diabetes management efforts are paying off.”

Researchers believe that there could be many factors behind the increased need for amputations in rural areas. Those include a lack of access to specialized diabetes-related care or public transit, fewer health care providers, lower income, and lower rates of health insurance coverage.

Dr. Akinlotan says, “If an individual doesn’t have health insurance, they’re less likely to get a regular check, and if the blood sugar is already out of control, the individual may not be aware or able to get care in a timely manner.”


In order to address the disparities found among different groups, she says it may be helpful to investigate cultural factors that could be at play. Ensuring ongoing comprehensive care for patients is also important.

According to the American College of Foot and Ankle Surgeons, nearly 85% of diabetes-related amputations are preventable with education and early intervention. To lower your risk of amputation, they recommend wearing proper shoes, inspecting your feet on a daily basis, ensuring they are also regularly checked by a doctor, and being proactive about treating minor injuries.

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