Medical groups back amputation prevention task force to tackle diabetes-related limb loss

Doctors, podiatrists and medical associations told the Joint Committee on Public Health that a state-level amputation prevention task force could reduce preventable limb loss and the associated mortality and costs.

Steven Hobby, vice president for state government affairs at the American Diabetes Association, said nearly 600,000 adults in Massachusetts have diabetes and proposed that a task force “take a systematic look at reducing amputations, recommend approaches to encourage collaboration among clinical stakeholders, and ensure access to treatments and services to prevent amputations, including coverage for evidence-supported treatment of diabetic foot ulcers and peripheral arterial disease.”

Dr. David Alper, a podiatrist representing multiple professional organizations, said the burden is concentrated in communities of color. “What's even more horrific is that 6 of these 7 are people of color…85 percent of these amputations are preventable with early intervention,” he said, and he urged state action to improve clinician awareness, coverage for preventive foot exams and earlier intervention.

Tyler Silverman, legislative chair and vice president of the Massachusetts Foot and Ankle Society, described in-hospital limb-saving teams and told legislators the task force would bring together endocrinologists, vascular surgeons, podiatrists, primary care, wound-care specialists and policy makers to improve early detection and access to cost‑effective care. He noted published data showing a five‑year mortality after major amputation near 50 percent and said preventing amputations can save lives and health-care dollars.

Why it matters: Witnesses said Massachusetts ranks high nationally for preventable amputations and that disparities in access and scope of practice have contributed to poorer outcomes. They urged a multidisciplinary, state‑led approach to promote early screening, coordinated wound care, and insurance coverage for preventive services.

Clinical examples and costs: Dr. Alper described a patient who presented with burns and diabetic neuropathy that ultimately led to toe and foot amputations; he said simple preventive exams are inexpensive compared with the cost of amputation. Multiple witnesses emphasized that coordinated care and insurer incentives for prevention could shift spending from reactive to proactive care.

Next steps: Sponsors requested that the committee report S.1508 and H.2433 favorably so the task force can be convened. Testimony included hospital clinicians who volunteered to serve or to supply data to a state-convened group.