After years of progress in reducing amputations, the number of diabetes-related lower limb amputations is now rising across the United States. A new study from the University of
Oklahoma reveals that Oklahoma has seen one of the largest increases. Between 2008 and 2019, the rate of amputations in the state nearly doubled. Both major amputations, such as the removal of a leg, and minor amputations, like the loss of toes or part of a foot, have increased sharply.
Dr. Kelly Kempe, a vascular surgeon at the OU School of Community Medicine in Tulsa, led the study, which was published in the Journal of Vascular Surgery. “Major amputations are rising, and significantly so,” she said. “No matter how you look at the data, the results are troubling.”
Diabetes can lead to serious complications when not properly managed. Over time, high blood sugar levels can damage blood vessels and nerves, especially in the legs and feet. Poor circulation can cause infections and slow wound healing, increasing the risk of amputations.
Another related condition, peripheral arterial disease, also reduces blood flow to the lower limbs, making it more likely that a person will require amputation.
To understand the factors behind these amputations, Kempe and her team examined 1.3 million anonymized patient discharge records from Oklahoma hospitals over a 12-year period.
They identified 15,642 cases in which patients with diabetes or peripheral arterial disease had undergone amputations. The overall rate of amputations nearly doubled, rising from 8.1 per 1,000 patients in 2008 to 16.2 per 1,000 in 2019. For comparison, the U.S. average is 4.9 per 1,000 adults, according to the Centers for Disease Control and Prevention (CDC).
The study also found that certain groups were more likely to undergo amputations. The highest rates were observed among men, American Indians, the uninsured, non-married individuals, and those between 45 and 49 years old. Interestingly, being married seemed to provide some protection, possibly because of better social support and access to healthcare.
There are several reasons why amputations are increasing in Oklahoma. One major factor is the high number of uninsured residents—nearly 14% of the state’s population lacked health insurance in 2021.
Without insurance, many people with diabetes cannot afford regular medical checkups, including blood sugar monitoring and foot care, which are essential in preventing severe complications.
“Having your blood sugar checked frequently does make a difference; that’s proven,” Kempe emphasized. “But in Oklahoma, health care access is a challenge, especially because we have one of the highest uninsured rates in the country and many rural areas with limited medical services.”
Another issue is the lack of specialized, team-based healthcare facilities. In many states, clinics offer coordinated care where patients can see primary care doctors, foot specialists (podiatrists), and vascular surgeons in one place.
These multidisciplinary systems have been shown to reduce amputation rates. However, this model of care is uncommon in Oklahoma, making it harder for at-risk patients to receive timely treatment.
Despite these challenges, there are efforts underway to improve care for those at risk of amputations. Kempe and her team recently launched a project to train primary care providers in the Chickasaw Nation on how to detect and prevent lower limb disease.
The success of this program led to an expansion with the Muscogee Creek Nation, and the final results of that study are currently being analyzed.
To address the growing number of amputations, healthcare experts and policymakers must take action. Kempe stresses that creating limb preservation programs and increasing public awareness are key steps.
“To be effective in any health care measure, you must tackle challenges at all levels, including policy,” she said. “But the first step is awareness. A good place to start is simply talking about the dangers, and the solutions.”
This study highlights the urgent need for better access to healthcare, especially in rural areas and among uninsured populations. By focusing on early prevention, improved medical care, and community awareness, the trend of rising amputations could be reversed, improving the lives of thousands of Oklahomans at risk.
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The research findings can be found in the Journal of Vascular Surgery.
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