By Eulalee Thompson, Staff Reporter 
About 50 per cent of
diabetic patients undergoing leg amputation will lose the other leg in two to three years.
NOT MANY persons with diabetes know their haemoglobin A1C level or even know what that means, says U.S. vascular surgeon, Dr. Michael Weingarten. He believes that this is an indictment on the medical community's handling of patients with this ever-increasing chronic disease.
"How are we dealing with this as a medical community? I would say not very well. I see patients coming in with their diabetes not well controlled and many of them have not had a medical examination in years... Their haemoglobin A1C levels were not measured routinely by providers," he said.
Dr. Weingarten was making a presentation, last week, on 'diabetes and the chronic wound' at The Medical College of Pennsylvania Hospital Wound Healing Programme, U.S. His presentation, along with others, was transmitted here and to other sites around the world via website.
The all-important haemoglobin A1C level which Dr. Weingarten spoke of, is a measure of the amount of glycosylated haemoglobin.
It is a blood test that measures blood-sugar control in persons with diabetes mellitus over an extended period. Usually, higher levels of glycosylated haemoglobin is associated with higher risks of developing complications from diabetes (such as heart disease, stroke, eye disease, kidney disease, nerve damage). Closer to normal levels are linked to a decreased risk for these complications.
In persons who do not have diabetes a small percentage of haemoglobin (Hb) molecules in red blood cells become glycosylated (that is, chemically linked to glucose). Older red blood cells have a greater per cent of glycosylated haemoglobin (GHb) and diabetics whose condition is poorly-controlled, where they are exposed to high concentrations of glucose in the blood for some time, will have a greater per cent of GHb
Inadequate attention to this measurement, Dr. Weingarten linked to the risk for the development of a common problem in diabetics, the non-healing wound on the lower extremities. Fifteen per cent of diabetics, he said, will be hospitalised with foot problems during their lifetime.
"To me the most astonishing thing is that 50 per cent of patients undergoing leg amputation will lose the other leg in two to three years and I see this in my own practice. It is really tragic to see this happen, this is why we as healthcare providers need to take this very aggressive approach to diabetes. You have to preserve these limbs because once you remove one limb, they are going to lose the other limb," he said.
Other ills will befall the person with uncontrolled diabetes the surgeon said that he will die easier of coronary artery disease within five years after losing the limb.
What is it about diabetes that leads to non-healing ulcers or wounds? One of the reasons that diabetics get peripheral vascular disease (PVD), disease of the blood vessels or arteriosclerosis, and they, in fact, develop a more aggressive PVD than non-diabetics. It is four to six times more common in a younger age in those who have diabetes,Dr. Weingarten said. In the Pennsylvania wound healing programme, they are seeing younger persons coming in with severe arteriosclerosis and even have a 37 year old patient in the hospital with gangrene and diabetes.
