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TX City: ‘Diabetic Foot Capital of the World’

Diabetes
Man with amputated leg | Image by Freepik

Sky-high diabetes-related amputation rates in San Antonio have doctors sounding the alarm.

Although Texas sees some of the highest rates of diabetes-related amputations nationwide, the City of San Antonio is the epicenter of this crisis.

“It’s a huge issue in San Antonio and dare I say, it’s the diabetic foot capital of the world, in terms of complications,” remarked Michael Sobolevsky, a podiatrist with the Texas Diabetes Institute (TDI) in San Antonio, per The New York Times. “We are constantly amputating.”

Individuals with diabetes can have issues controlling their blood sugar levels, which in turn can lead to peripheral arterial disease or peripheral nerve damage, according to the CDC. Poor blood supply can make even the tiniest cut or sore a significant health problem and lead to complications, including gangrene, which can require amputation. The lower extremities tend to be the most impacted by this complication.

The loss of a leg or foot due to diabetes diminishes a person’s five-year survival rate, according to the American Diabetes Association (ADA). In Bexar County, the diabetes mortality rate is 36.3 per 100,000 people, which is considerably higher than the national average of 25.4.

Of the 154,000 Americans who lose a limb due to diabetes-related complications, people of color are disproportionately affected, per the ADA. This trend is also apparent in San Antonio, where Hispanic men are three times more likely to undergo these amputations than women.

There are several possible explanations for this, one being cultural.

Julius Hunter, a program coordinator with San Antonio’s Diabetes Prevention and Control program, told NYT that men are taught from a young age to “tough it out” and ignore the cuts and legions that could be pointing to signs of serious diabetes complications.

“‘Are you a man, or are you going to cry like a little boy?’ Those messages carry all the way to adulthood, especially for men of color,” explained Hunter.

This can lead to males ignoring pain or health issues until they have grown severe enough to require hospitalization, whereas their female counterparts might more actively seek treatment early on.

Type 2 diabetes has also been shown to disproportionately affect minorities, with Hispanics living in the U.S. being some 17% more likely to have the metabolic disorder than non-Hispanic white people. Research has also found that Hispanic populations are genetically predisposed to insulin resistance and glucose intolerance, which can result in type 2 diabetes. Moreover, socioeconomic factors, including low income, low education, and a lack of health insurance, can increase a person’s diabetes risk.

A major driver of type 2 diabetes is being overweight or obese, with these rates skyrocketing not only in Texas but worldwide over the past few years, as covered in The Dallas Express. WalletHub named San Antonio the 21st fattest city in the country, while over 76% of the adult population in the larger metro area were considered either overweight or obese, per NYT.

TDI is located in western San Antonio, which is historically an area for Hispanic communities. Around 80,000 patients are treated there each year, with Sobolevsky aiming to drive home the fact that they should seek medical attention for any sores or cuts on the feet or legs in order to avoid amputation.

“My job is to prevent, save, save, save,” he told NYT.

However, Dr. Ralph DeFronzo, an endocrinologist and diabetes expert affiliated with University Health, which runs TDI, estimates that there are many diabetes cases going undiagnosed in the city.

“Here in San Antonio, if you actually went and tested all of the people, you would find that probably one in every two individuals over the age of 40 has diabetes,” he told NYT.

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