Border Diabetics Face Higher Amputation - - Tyler, Longview, Jacksonville |ETX News

12/9/06-El Paso, TX

Border Diabetics Face Higher Amputation

Diabetic amputee group in San Antonio encourages patients, doctors. Diabetic amputee group in San Antonio encourages patients, doctors.
Nearly every day, Dr. Lawrence Harkless sees a waiting room full of diabetic patients with foot sores, some cases so bad that amputation is the only answer.

Many of those patients live along the Mexican border and travel to Harkless' San Antonio clinic for urgent care. Diabetics on the border are twice as likely as other diabetic Texans to have to resort to amputation, according to a recently released study from the U.S. Centers for Disease Control and Prevention. The study is based on 2003 data.

Border residents accounted for 19 percent of all hospitalization fees for diabetes-related amputations in 2003, but make up only 10 percent of the state's population, the study said.

CDC epidemiologist Eric Miller said the lopsided amputation rates are prompted by limited access to medical care and education along the border, and poverty.

Large populations of Hispanics, who make up about 85 percent of border residents and are already genetically predisposed to developing diabetes, may also contribute to the higher amputation rates, Miller said.

Susan Young, a nurse consultant for the diabetes section of Texas' Department of State Health Services, said Miller's study supports what health officials have long assumed and said the cause is a complicated combination of factors.

"It's an access issue, it's a political issue, it's a social issue," Young said.

Harkless, who specializes in treating diabetic foot problems and chairs the Texas Diabetes Council, said many of his patients are both poor and uninsured.

By the time they find their way to his office, it may be too late.

"For anybody that we admit for a diabetic foot problem, the likelihood of amputation is high," Harkless said of the more than 300 patients he admits to a hospital every year. "Some of them may come in early enough that they can just go on antibiotics, but that is the exception, not the rule."

Dietitians and doctors say the solution is theoretically simple: Improve the quality and frequency of medical care and education about the disease for diabetic patients. But that's far from easy to change.

"There are some communities in Texas where I'm sure there are cultural barriers," Young said. "There are some people (along the border) who get episodic care...for acute conditions that aren't being managed."

For many residents along the Texas border, a 1,200-mile stretch of rugged desert dotted with small cities and towns, doctors with specialized training in diabetes treatment, are few and far between.

Some Texas border counties have only one doctor, the Texas Medical Association said.

More populous counties, such as El Paso and Cameron, the county seat of Brownsville, have several hundred doctors. But seeing those physicians is still a challenge in areas where nearly a quarter of residents don't have insurance.

Nationally, about 25 percent of border residents live in poverty.

Harkless said that poverty combination often means that patients wait until the situation is out of hand. Some of those patients put off treatment because they don't even know they are diabetics.

"Many times the diabetes diagnosis comes with the amputation," Harkless said.

Poverty can also limit a diabetic's ability to control the disease, compounding the problem.

"One of the hallmarks of treating diabetes is eating well," Young said. "Eating well is expensive."


Source: AP

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