Losing a foot to diabetes is terrifying, and preventable. How doctors are trying to help

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Duane Lea is terrified of needing an amputation, or worse.

The 46-year-old Toronto resident lost his right foot to a blood clot when he was in his 30s and is now constantly on alert about losing the left leg to diabetes.

“It is like the fear never leaves you,” Lea said during a checkup for his pre-diabetes at Toronto’s Black Creek Community Health Centre.

Lea uses a cane and manual wheelchair, which he said limits his ability to work or enjoy martial arts as he once did. 

“If I lose this leg, I lose all ability and I probably would be wheelchair bound.”

Lea’s father in Jamaica has Type 2 diabetes, a grandmother was blind and an aunt lost her vision in one eye due to the disease.

Untreated Type 2 diabetes can also lead to devastating consequences like leg and foot amputations, particularly among Black Canadians. It is an issue doctors are working to understand and solve with early screening and more.

A woman with long, black hair wearing a pink blouse and light blue pendant.
Dr. Azza Eissa aims to prevent complications of diabetes through early screening. (Turgut Yeter/CBC)

While Canada has little race-based medical data, Black patients in the U.S. had triple the amputation rates as others.

Delayed diagnosis?

A report by Statistics Canada from 2023 showed a Black man is twice as likely to die from diabetes complications (5.3 per cent) as a white man (2.5 per cent), with similar rates in women (4.8 per cent versus 2.4 per cent).

Dr. Azza Eissa, a family physician and researcher at St. Michael’s Hospital in Toronto, said Black communities in Canada are experiencing an epidemic of amputations due to untreated diabetes.

“I think one of the top reasons is delayed diagnosis,” Eissa said. “When you diagnose diabetes late, you treat it late, it’s already more severe so then they’re more likely to get amputations.”

“Because Black Canadians are more likely to get diabetes [younger] they should be screened earlier at 30 or 35,” Eissa said. 

A female doctor, right, examines a diabetic ulcer on the foot of a man at a clinic.
A physician, right, examines a diabetic ulceration on the foot of Johnny Adams in Venice, Calif., in 2009. Foot checks can prevent many diabetes-related amputations. (Lucy Nicholson/Reuters)

Eissa has also found South Asian people were also less likely to be screened for diabetes than people who are white. But the racial disparity did not exist for cervical cancer programs, which send out reminders about screening. 

Eissa said she thinks more should be done to let all Canadians know they should be screened for cancers and diabetes. 

Nerve damage in the extremities, or diabetic peripheral neuropathy, is one of the long-term complications of diabetes. People can lose sensation in their feet and may not notice a cut or sore.

But left untreated, the damage can lead to infection and limb amputation, according to Diabetes Canada, making diabetes-related complications the top cause of lower-limb loss in the country.

Eissa said people then need amputations to prevent the body from going through sepsis, the medical term for blood poisoning, which can be fatal.

Why Black patients have lower screening rates in Canada isn’t well understood, Eissa said, adding it’ll take quality research to figure out.

Scalable solution

In the meantime, at Toronto General Hospital, Nicole Woods created a program to train personal support workers (PSWs), including those who work in clients’ homes, to quickly identify what could become a problematic wound and direct people to care.

Wood said foot checks can prevent 85 per cent of diabetes-related amputations. 

“This is vital,” said Woods, a researcher with the Institute for Education Research at Toronto’s University Health Network. “It is amazing because it is so simple. It is a really scalable solution to what otherwise feels like an unmanageable problem.”

A woman in a navy t-shirt and necklace.
Psychologist Nicole Woods introduced a program to train personal support workers to check the feet of people with diabetes in their own homes. (Turgut Yeter/CBC)

As part of the training, PSWs are taught to look for breaks or openings in the skin anywhere on clients’ feet, as well as check for thickening of the toe nails that could indicate a fungus. They also test for loss of sensation from reduced circulation that can occur in people who have diabetes.

“Black Canadians have less access to primary care, they have less trust in the health care system, justifiably so,” Woods said, given systemic failures not only in health care but historically in society. 

To try to address that, Wood said Toronto’s Best Foot Forward program brings foot screening to people they already trust, perhaps even nail salon workers, instead of requiring patients to seek out and find medical care. 

Diabetes Canada calls for access to publicly funded services and devices for all people with diabetes to prevent and treat foot ulcers and avoid amputation. The group also recommends that people who live with diabetes take their socks off as soon as they get into an exam room for a diabetes-related visit as a reminder to ask their primary care provider for a foot check.

Back at the Black Creek clinic, Lea urged Black Canadians to talk about the problem because foot checks are a small but potentially life-changing step.

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Lea also called for more grassroots efforts to address food insecurity so people with diabetes are able to afford foods to keep blood sugar levels low, as well as screening. To that end, the community health centre offers free blood glucose checks.

“In the community we need awareness,” Lea said.

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