Such studies are also important in designing clinical practice guidelines. In a 2003 paper published in the journal Diabetes Care, Dr. Wrobel looked at diabetes-related foot outcomes at 10 Veterans Affairs medical centers and found a correlation between coordination of preventative foot care and lower amputation rates. In a 2001 study that also appeared in Diabetes Care, he previously found sizeable geographic variations in lower-limb amputation rates among Medicare patients and concluded that keeping or losing a toe, foot or leg depended on "systematic differences in preventative care and treatment decision making."

Dr. Wrobel emphasizes the need for coordinated patient care and communication among health care providers.

"The delivery of health care in this country happens too often in isolated pods - insurance companies, managed care providers, fee-based care," Dr. Wrobel said. "There has been very little patient advocacy. Problems with diabetes are too pervasive for care not to be more coordinated. We're beginning to see it now, bubbling up from patient frustration."

But in 10 states, according to Chad Appel, APMA state advocacy associate, Medicaid programs do not reimburse for podiatric care, including California, Michigan and, effective Oct. 1, Arizona, where indigenous populations suffer higher rates of diabetes and related complications.

"Budgets are hurting and they have to look for somewhere to cut and right now, podiatric are is an optional service under Medicaid," Appel said.

The Thomson Reuters study, which was presented July 17 during the APMA's annual Scientific Meeting in Seattle, adds to the body of evidence that shows that including podiatry in a multidisciplinary, coordinated effort to treat diabetes could prevent up to 50 percent of related amputations and the pain, depression and loss of quality of life that often follow.

SOURCE Rosalind Franklin University of Medicine and Science