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Nontraumatic lower extremity amputation is a complication of inadequate diabetes control. It is typically preceded by peripheral diabetic neuropathy and peripheral artery disease, which can predispose patients to foot ulcers and infections that lead to limb loss.

In their July issue paper, Hamlet Gasoyan and coauthors perform a systematic review of the literature about disparities in rates or levels of diabetic neuropathy and lower extremity amputation in the US.

The authors examine the demographic factors, barriers to health care, and social determinants of health associated with the rates of both conditions among US adults during the period 2000–2020.

They find that a number of studies report interrelating factors, including patient, provider, and payer variables, associated with diabetic neuropathy and lower extremity amputation.

Furthermore, Gasoyan and coauthors observe race-dependent treatment patterns in the studies they examine.

The authors note that Black patients had a higher likelihood of presenting with peripheral arterial disease undergoing a lower extremity amputation, whereas White patients were more likely to receive a lower extremity arterial revascularization procedure aimed at limb salvage.

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Today in Health Affairs Forefront, Katie Keith discusses the proposed rule from HHS to significantly revise the agency’s prior interpretation of Section 1557 of the Affordable Care Act, which prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities.

Cynthia Ho and Liza Vertinsky discuss how getting a clearer picture of the true costs and risks of drug research and development is a critical starting point in ensuring a more balanced and accurate policy approach toward biomedical innovation.

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