Medical experts sound the alarm on growing diabetic amputations among Black patients

Doctors say early detection and medication can prevent amputations.

February 19, 2024, 2:08 PM

In operating rooms across the country, more and more diabetics are receiving amputations due to complications from type-2 diabetes.

The life-altering procedures are more common among Black and Latino patients who are more likely to be diagnosed with the disease, according to health data.

Doctors perform surgery on a patient.
ABC News

Despite the grim figures, medical professionals said that diabetics can avoid losing a limb, but due to a lack of awareness of treatments, many minorities are missing out on this critical care.

"The reason I did not go to the doctor or anything, [is because] I didn't want to hear the doctor say 'We have to take your leg,'" Shelton Echols, a diabetic amputee, told ABC News.

Health experts, however, said that there is a new push to get the right medications and treatment to these patients earlier and avoid going under the knife.

Echols said that he was well aware of his diabetes and health problems but never really took action on it.

He said his hemoglobin A1C tests showed his levels were 14%, well above normal. A normal A1C is considered to be below 5.7%, according to medical experts.

"So I was playing Russian roulette with my life at the time because I was in denial," he said.

Shelton Echols talks about his experience losing a leg to diabetes.
ABC News

Things changed one day when Echols noticed a cut on his left leg that wasn't healing. Doctors discovered that his diabetes cut off circulation to his legs and they needed to amputate his left leg.

"I really had a sense of peace for the simple fact that I knew in my heart everything was my fault. Everything was my fault," Echols said.

His story is becoming far too common among Black and Latino diabetics, according to health data.

Complications from the disease, specifically peripheral artery disease (PAD), can cause decreased blood flow and lead to wounds that remain open, according to health experts. And it’s this complication that can lead to the affected limb needing to be severed.

Complications from peripheral artery disease (PAD) can lead to amputation.
Johns Hopkins Medicine

The number of diagnosed diabetics nationwide is up more than 7%, since 2001, according to data from the National Institute of Diabetes and Digestive and Kidney Diseases.

Over that same period, the number of those people needing to have a limb removed has grown by 18%, the data showed. Roughly 154,000 toes, arms, legs, and feet are cut off every year, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Across all racial and ethnic groups, the number of diabetic Americans is rising, and so is the number of them needing amputations. But a health study published in September found Black and Latino diabetics are four times more likely to get an amputation than other ethnicities.

Drs Richard and Lauren Browne speak with ABC News.
ABC News

Dr. Richard Browne, a Charlotte, North Carolina-based cardiologist, told ABC News that one of the factors behind the problem is the fact that many Black patients are not getting the right information about their diabetes early on.

"Very often, their symptoms are ignored," Browne, who is also a senior medical executive at Johnson & Johnson, said.

Browne and his wife Lauren, who is also a physician, said they experienced this problem firsthand with Lauren's diabetic father.

Russel Nandlal was a boxing coach for world champion Julian "The Hawk" Jackson. Doctors had to amputate both of his legs and an arm before he died in 2003.

Browne said looking back, his father-in-law was not given options to treat his PAD.

"And I also feel that there is what we call unconscious bias, where sometimes you get in front of a patient and you make your own determination that, 'Hey, you know, maybe he can't come back three or four times for the appropriate care for his PAD. So I'm going to do him a favor and just amputate, delay and get it over with at this point,'" he said.

Richard and Lauren Browne said that with the right treatment severe amputations can be avoided altogether.

Six years ago, Jay Bradley Starks said he was told by a doctor that they needed to amputate below his left knee after a bout with frostbite led him to a surprise diagnosis of PAD.

Starks said he went to another physician, who was also Black, and he was able to just amputate his foot due to stents and diabetes medication.

Jay Bradley Starks speaks with ABC News.
ABC News

"My surgeon had a great understanding of who I was, as opposed to the initial one. There was a class difference, a race difference, a socio-economic distance," Starks said.

"Controlling your A1C matters when you’re at the onset of the disease, you have an opportunity to do it," he added.

Among the medications Starks is taking is Ozempic, an FDA-approved drug that is prescribed for diabetes patients. The drug mimics a hormone in the body that makes you feel full.

The drug has been shown to drop blood sugar levels and one medical study found that Ozempic and similar drugs can lower the risk of amputations by as much as 50%.

Despite these advantages, medical experts say some Black diabetic patients are hesitant to use them.

An Ozempic (semaglutide) injection pen is seen on a kitchen table on Aug. 6, 2023.
Jaap Arriens/NurPhoto via Getty Images, FILE

Dr. Veronica Johnson told ABC News that many of her patients have a distrust of medications.

"Even though they're not insulin because of [some patients'] previous experiences and things that they found in the past or their family members who are placed on insulin and they were like, 'That's the end,'" she said.

Johnson and other doctors recommend a simple screening for all Diabetics concerned about losing a limb.

The ankle brachial index, or ABI test, compares the blood pressure in the upper and lower limbs If the differences are too great, then there’s a problem with circulation and doctors can advise a treatment.

The procedure is not covered by Medicaid or Medicare for patients who aren’t already showing symptoms. There are legislative efforts underway to try and change that.

Dr. Veronica Johnson speaks with a patient.
ABC News

Dr. Richard Browne has been traveling the country with Johnson & Johnson raising awareness of the issue and imploring Black patients to not wait on treatment before it gets too late. He said he hopes that when patients hear him and his personal family story, they will seek help.

"Quite frankly, there is evidence that if you are taken care of by someone who looks like you, you're more likely to comply with their recommendations," he said.