COMMENTARY

Prediabetic Feet Deliver Profound Message

Anne L. Peters, MD

Disclosures

November 15, 2016

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Hi. Today I am going to give you sort of a public service announcement about preventing diabetes. This is partly because I am doing a clinical trial known as D2d, looking at the use of vitamin D to prevent the progression to diabetes in people with prediabetes.[1]

As the principal investigator on that trial, I look at all of the patients when they come in to the trial and I do a physical exam. I want to point out that I am doing this trial in East Los Angeles, which is a primarily Latino population in a poorer part of town, in a building where I take care of patients who already have diabetes—many of whom have not had access to good healthcare and ended up with many complications—as well as patients who we are screening for enrollment into our diabetes prevention trial.

 
I see the damage that diabetes causes.
 

I can tell you that the patients who come in for the prevention study look similar to the patients who have diabetes. They may be a little bit younger, but by and large, they look about the same. But when I take off their shoes and socks and look at their feet, it is unbelievable, because these patients with prediabetes have normal feet.

I know this sounds odd, but I have spent my lifetime looking at the feet of people with diabetes, and I see the damage that diabetes causes. I see the reduction in pulses, the abnormal nails, the disruption in foot architecture, the red and slightly swollen look of a neuropathic foot. I see calluses. I see foot after foot that is not really awful but is not normal.

When I look at the feet of these people with prediabetes, they have normal feet. Their feet are not damaged yet. I compare them when I am working in clinic another day of the week seeing actual patients with diabetes, and their feet are not right. They have had diabetes damage, and you know that they are progressing to getting complications.

I tend to be an optimist in life, and I tend to think that we can prevent complications. When I read published articles that say that maybe we should not worry about diagnosing prediabetes because we are not going to reduce mortality by treating prediabetes, I say, "Yes, but look at the health; look at the health that we are going to help people maintain if we can diagnose this earlier and make sure that they get appropriate care."

Perhaps patients are never going to know what damage we are sparing them. Perhaps it is hard to know whether your quality of life is better or worse for an event such as a foot ulcer that you are never going to have. But as a clinician, I am a real advocate of early diagnosis of diabetes, of diagnosing prediabetes, of providing education, and of providing lifestyle programs.

All over the country, for patients who are on Medicare and patients who have access to a YMCA, we are seeing increasing funding for these types of programs that can help people change their lifestyles and help prevent progression to diabetes. For most people, when they find out that they have a problem, that they have a slight elevation in their blood glucose levels and their A1c is entering the prediabetes range, it really helps to motivate them.

Most of all, I want to keep them free from harm.

In my own personal experience, being able to compare and contrast what people look like when I examine them in this prediabetic state further empowers me to go forth and encourage all of you to think about prediabetes, to work with your patients, to provide resources to allow them to engage in a healthy lifestyle, and then treat with metformin or whatever other agents seem appropriate to help prevent diabetes or treat diabetes early.

Thank you. This has been Dr Anne Peters for Medscape.

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