Studies examine diabetes’ effects on lower limb amputation, dementia risk

Wellness visits, cardiometabolic disease prevention reduce chances, according to researchers.

Patients with diabetes who participate in free annual wellness visits covered by Medicare can reduce the likelihood of amputation by 36%.

Meanwhile, patients with type 2 diabetes (T2D), along with heart disease or stroke, have double the risk of developing dementia later in life.

The findings were part of two separate studies published this month.

Amputation

Researchers from the University of Virginia (UVA) School of Medicine analyzed data from patients in the “Diabetes Belt,” 644 counties in 15 states in the southeastern and Appalachian regions of the United States, from 2006 to 2015, according to a news release from the UVA Health System.

Patients living in the Diabetes Belt had a 27% greater chance of requiring a lower-extremity amputation, compared to residents of counties surrounding the belt. Odds of an amputation were 36% lower for patients that used the free annual wellness visit covered by Medicare, regardless of where they lived.

“Our results confirmed our hypothesis that annual wellness visits are associated with a reduced risk of major lower-extremity amputations, highlighting the importance of connecting patients to preventive care services,” Jennifer Lobo, PhD, a researcher in UVA’s Department of Public Health Sciences, said in a news release.

Data showed significantly higher rates of diabetes-related amputations among Black patients compared to White patients inside and outside the Diabetes Belt, so policy change is needed to remove systemic barriers to preventive care, according to the researchers.

The researchers presented the findings June 5 at the American Diabetes Association’s Scientific Sessions in New Orleans.

Dementia

Preventing diabetes and cardiovascular disease could be a strategy for reducing risk of dementia, according to the study “Cardiometabolic multimorbidity accelerates cognitive decline and dementia progression,” published June 16 in Alzeimer’s & Dementia: The Journal of the Alzheimer’s Association. The Swedish Karolinska Institutet also published a news release on the findings.

Researchers examined effects of having multiple cardiometabolic diseases (CMDs) – T2D, ischemic heart disease, heart failure, atrial fibrillation and stroke – among 2,500 healthy, dementia-free patients over age 60 living on Kungsholmen island in Stockholm, Sweden. Patients were followed for 12 years and the presence of more than one CMD doubled the risk of cognitive impairment and accelerated the risk of cognitive decline by two years.

“In our study, the combinations of diabetes/heart disease and diabetes/heart disease/stroke were the most damaging to cognitive function,” Abigail Dove, doctoral student at the Aging Research Centre in the Karolinska Institutet, said in the news release.

Patients with one CMD did not have a significantly greater risk of dementia – good news because it may be possible to avert dementia by preventing development of a second disease, Dove said. The correlation between CMDs and dementia risk was stronger for patients younger than 78.