A nurse at Naval Hospital Jacksonville cares for the foot of a patient with diabetes. (Credit: Michelle Pereira/U.S. Navy/Wikimedia Commons) A nurse at Naval Hospital Jacksonville cares for the foot of a patient with diabetes. (Credit: Michelle Pereira/U.S. Navy/Wikimedia Commons)

The Affordable Care Act (ACA) Medicaid expansion program may have helped many people with diabetes keep their feet.

Dr. Tze-Woei Tan, a surgeon on the faculty of the University of Arizona medical school, and colleagues have published data supporting that possibility in an analysis of data on 25,493 non-white Medicaid enrollees and 9,863 uninsured patients who suffered from diabetic foot ulcerations, or a sore or wound that would not heal.

For minorities ages 20 to 64, with Medicaid in states that used ACA money to expand their Medicaid programs early, the number of hospital admissions for diabetic foot ulcerations climbed 181%, and the number of diabetic foot ulceration admissions for uninsured patients fell 21.5%.

In an early-Medicaid-expansion state, the odds that doctors would cut off the toe of a patient with a diabetic foot ulcer, or perform another form of “minor amputation,” increased 14%.

But, because surgeons performed relatively minor procedures in time to keep infections from spreading, the odds that surgeons would have to perform “major amputations” — amputations of the foot above the ankle, or even amputations of entire legs — fell 17%.

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The picture was different in states that declined to expand their Medicaid programs.

There, the number of hospital admissions for uninsured people with diabetic foot ulcerations increased 78%.

The odds the patients with diabetic foot ulcerations in the non-expansion states would have toe amputations, or other minor amputations, fell 8%, but the odds that they would lose their feet or legs increased 1%.

The researchers came up with the patient sample by looking at state inpatient databases for 19 states. The records were for patients with diabetic foot ulcers treated from 2013 to 2015.

Tan presented the team’s findings Sunday, during web-based scientific meeting sessions sponsored by the American Diabetes Association.

The association says, in an announcement describing Tan’s session, that Tan’s research is important because up to one-third of people with diabetes will develop a foot ulcer, due to problems such as loss of sensation in the feet and blockage in the arteries.

Tan said in a comment included in the announcement that the results suggest that patients with diabetic foot ulcerations in Medicaid expansion states “might be seeking care earlier and were able to prevent major leg amputation.”

“African Americans, Hispanics and those without health insurance have disproportionately higher risks of lower extremity amputation, so access to care for patients with foot ulcers is vital,” Tan said. “The broadening of the ACA may reduce disparities in diabetes-related amputations.”

 

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