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This podcast is presented by the Centers for Disease Control and Prevention. CDC – safer, healthier people.

[Dan Hazelwood] Thank you for joining us for this edition of Clinical Diabetes Management, brought to you by the National Diabetes Education Program, or NDEP. NDEP is a joint initiative of the Center for Disease Control and Prevention and the National Institutes of Health. I'm your host, Dan Hazelwood. Our topic today is amputation prevention in diabetes. Every 24 hours, nearly 230 diabetes-related amputations are performed in the United States. Joining me today is Dr. Dennis Frisch, from the American Podiatric Medical Association and a member of the National Diabetes Education Program. Welcome, Dr. Frisch.

[Dr. Frisch] Thanks you, Dan. I'm happy to be here.

[Dan Hazelwood] Dr. Frisch, why are people with diabetes at risk for amputations?

[Dr. Frisch] People with diabetes have a high rate of neuropathy or nerve damage. They also have increased vascular disease, or blood vessel disease, which is commonly referred to as peripheral arterial disease or PAD. These conditions put them at higher risk for injuries to the feet which can progress to ulcers that won't heal and infections which can lead to amputation.

[Dan Hazelwood] What is the monofilament test?

[Dr. Frisch] A monofilament is a nylon line, very similar to a fishing line, that can be pressed on a series of locations on the bottom of the feet. When we measure how it bends and whether the patient can feel these sensations, we then know that the patient has loss of protective sensation. Loss of protective sensation increases the chance that a patient cannot feel wounds or injuries to their feet which leads to the above-mentioned complications.

[Dan Hazelwood] What if a health care professional determines that his or her patient is at high risk for a foot ulcer?

[Dr. Frisch] There are several steps that you should take. Remember to control the ABCs: hemoglobin A1C, blood pressure, and cholesterol. Teach the patient how to do a daily foot check and the importance of daily foot care. Promote tobacco cessation. The patient may also benefit from special protective shoes or further diagnostic tests or interventions.

[Dan Hazelwood] Where can health care professionals go to get more information about diabetes and amputation?

[Dr. Frisch] The NDEP offers a number of free tools for clinicians. One of them is a kit called "Feet Can Last a Lifetime" which teaches proper use of the monofilament test. Another is a monograph entitled Working Together To Manage Diabetes: A Guide for Pharmacists, Podiatrists, Optometrists, and Dental Professionals. This guide focuses on the importance of team care and the critical concept that these health care professionals should understand about diabetes. We want to make sure that all members of the health care team recognize potential complications early and know what to do to intervene. Both of these tools are available on the NDEP website at www.YourDiabetesInfo.org.

[Dan Hazelwood] What else is available from NDEP?

[Dr. Frisch] NDEP also has materials for patients on diabetes control and prevention in English, Spanish, and fifteen Asian and Pacific Islander languages, as well as materials for specific groups, such as children with diabetes and ethnic minority groups.

[Dan Hazelwood] Dr. Frisch, what is the one take-home message you’d like to leave with our listeners?

[Dr. Frisch] Early recognition of diabetic complications, as well as patient education and prompt referral to a podiatrist can go a very long way towards amputation prevention.

[Dan Hazelwood] The National Diabetes Education Program, or NDEP, has more information and free educational materials for health care professionals and for people with diabetes. Visit www.YourDiabetesInfo.org or call toll free, 1-888-693-NDEP.

For the most accurate health information, visit www.cdc.gov or call 1-800-CDC-INFO, 24/7.