If I have diabetes, how can I avoid needing a foot amputation?

Many foot amputations could be avoided if people with diabetes did a better job of controlling their blood glucose levels. That’s the conclusion of a recent study led by podiatrist Jason Hanft, DPM, who worked with epidemiologists at Harvard and podiatry residents at South Miami Hospital in comparing the healing time for foot wounds with blood glucose levels in 500 patients.

Dr. Hanft concluded that for every 1% increase in A1C levels, there was a 3% slower healing rate in diabetic foot wounds. (A1C is a blood test that measures average blood glucose levels over a three-month period.) “That means someone with an A1C level of 8 will heal much more slowly than someone with an A1C of 6,” says Dr. Hanft. He is the medical director of the podiatry residency program at South Miami Hospital and also on the staff at Baptist Hospital.

“The study shows that it is more important than ever for people with diabetes to get their blood sugar under tight control,” Dr. Hanft says. He says that doctors usually begin treating out-of-control blood sugar levels with moderate means, such as diet and pills, and move to insulin only when all else fails. But after seeing how high blood sugar impairs wound healing, he now feels that doctors should be more aggressive. “When test results are elevated, this should be viewed as an urgent problem that requires immediate intervention using the most intensive therapies available,” he says.

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